21602 86TH PL W.PDF11111111 lill
8250
21602 86TH PL W
fILERECE IV E I I efo
CITV OF EDMONDS Permit No.
COMMUNITY SERVI s tMAN
RIGHT -OF -WA Y CONSTRUCTION PERMIT Issue Date
F7 APR 101 '
Z
0
W
C/)
U
04
0
�1.
A. Owner: —Washington Natural Gas Compad'y""It.*'4p"'9!�ontractor:
Naff mercer street Name
o 5+rlr--t I .
NLailiR.Ndress. Mailing Address
ea e WA 98111 5FIr.9i
City State Zip City State Zip
State License Number Telephone Number
21602 86 Place West
C. 9 Address or Vicinity of Construction:
Install New Service
Type of Work to be Don
D. 0 Work in Connection With: [I Sub or Plat D Single Family 0 City Projects
El Commercial El Multifamily XX Utility
E. 0 Pavement Cut: K1 Y 0 N F. 0 Size of Cut: 2 X 4 (1) @ Gas
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kirid"or description whatsoever, folseen . or unforseen, that may
be made against the City of Edmonds, or any of its �,partmentk or emple ees,J�cluding or not limited to the defense
of any legal proceedings including defense cc r1lecos, R4 Tes �y rieaion of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hournotice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in.accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature:
Date:'March 28, 1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY-- QAJ
Time Authorized: Void after da*s,.
Special Conditions:
PERMIT FEE:
Restoration Fee:
Receipt No.:
Fund 11.1 Fee -
Street Cut Dimensions: - x $
RELEASED BY:\A
Date INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
(Fund III - Route copy to Street 13ep"t-i
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
I tar)? ov n \k 622-6767 x 2588
X4)
WA-11:-:P- MAIN tx7--Fr4
I Im W-kinwNi
C-) 0 5- r I N4, C= t -!2�. if/ eAS AAAIkJ
KEY
-ss- sanitary sewer
-s- storms
-w- water
0 water valve