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City of Edmonds
ONSTRUCTION
EUM
PIT Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 211708 82 Av W (9424119)
B. Type of Work (be specific): Install New Service
C. Contractor: -Washington Natural Gas Compagy "� Contact: Frank Swan
Mailing Address: 815 Mercer St, Seattle, WA Phone: 224-22798
70t It
State License #: Liability Insurance: ]Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. n Commercial E] Subdivision F-1 City Project K] Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family 0 Single Family El Other
INSPECTOR: INSPECTOR: Wk-kyfi
F. Pavement or Concrete Cut 0 Yes E]No G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AD N
INDEMNITY. Applicant understands and by his signature to this application, aggrees to,ho d th City ofEdmonds harmless
m injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made again )Te--C
,#t'the �ty of Edmonds, or a fl its d 'artments or
employees, including or not limited to the defense of any legalproceedings includin5 !..L, and aitorney fees by rr on adin 'thispermit.
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THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A031PERIOD OP"'ONE YEAR L
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATEDRFSTORATIONFEES BE HELD UNTIL F L S T PA TCH
IS C OMPL E TEO B Y CI T Y FO R CES, A T WHI CH TIME A DEBI T OR CREDI T WIL L B E PR 0 CFtE ID FO R ISS 1. A NC E TO T HE A PPL I CA N T.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoratioil is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordanqod�#b @jty�d
gulations as required by thlCity Engineer.
- el�_
All street cut ditches shall be patched with asphalt or City approved material prior,,to e iWqfting da?,
NO EXCEPTIONS.
Ihave read the above stateme
,vts and understand thepermit requirements and thepink copy of thepermit will be
available on site at me f� �'rposes.
s
Signature: 5��w Date: July 25, 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Fngrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111*��-�Route copy to Street Dept.)
YES
Date:
Date:
El NO
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Addlendu-M to City -.Of X&O'hd
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APPLICATION
for
The City of Edmonds SIODE SEWER PERMT EASEMENT No . ..........................................
4 EW CONSTRUCTION REPAIRS 0
M f0v I L I'Z) 2-
Fp, .* E—=Pp,\,/ k t--\ V-AC)M E <�D\N
OV*rNER .............................................................................................................. CONTRACTOR ........................ ......................................................................... PERMIT No.4.5�..4..r-2
\t*-J�-=!-:-S-T (LN�'A IE-) LEGAL DESCRIPTION: LOT No . ............
ADDRESS.......................................................................................................... ............................ BI.0CK No . ............................................
NAMEOF ADDITION .... ..................................................................................................................................
0
Approv - /
. / A
DATE...
10 . / � ... ....... ....... .
APPLICATION
for
The City of Edmonds SIEDIC w
NEW CONSTRUC REPAIRS 0 EASEI(ENT NO . ............... . ...... ..................
n
.... Ig
OWNER &?j .... 'A .....
. /- --------------------------------- ............... CONTRACTOR .......... ................................................................................. - PER)=
ADDRESS 217,0eF---XZ.�e t .............................. LEGAL DESCRIPTION: LOT No . ...... w ........ q ..................... BU)CK 10 - --- - ------ * ........... * ...... * ......
NAME oiF ADDITION ..... ... Angl4ir), . .........
.............................................. ..... I ..........
ktd OVIEE)"
APR 18 1974
J!P"
a
T
141
4
37
. I
Approved:
DATE................................................ ft .........
our
0
NOTICE:
N:o warranty of a.-ccuracy.
The information *shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.onds does not ' warrant the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-map(s), including, but not limited to,
th-e location of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
I I b e l-`1 a. b.-II.-e f o r 11 h e
emp-to-yee-s o-r off ice,rs,sha-r
information given on this, map(s), nor for
ion provided based
any one representat'
upon . said map(s).
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION ......... 21708 82nd Avenue West
----------------------------
PROPERTY LEGAL DESCRIPTION .............. Lot No. Oden's Addition
.................. . .................................................................................................................................................
.......................................................................................................................................................................................................................................................
................................................................ OWNER AND/OR BUILDER .... Mr. & Mrs. Bob Ervin
.......................................... ............................. . .......................................................
CONTRACTOWS NAM & ADDRESS ..... Mr- & Mrs. Bob Ervin, 21708 82nd Avenue West
----------- * ---------- * ----------------------------------------------------- - --------------------------------------------------- ... * ----------------------------------
Permission Is granted ----------- - Ap-ri.1 .... 1.8 ............ ------------ 19.. 74, for rePair and/or connection of a side sewer to the city sanitary sewer
.. .. .... .. ... ------
sysil—il in accordance with City of Edmonds ordinances.
ATT-4TION IS CAliff-ED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street axea. Do not cover any portion of sewer before it has been Inspected.
NOTE No, 2—All work performed in city right-of-wav requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3---Obtaln full information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at Property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date ---- --- ................... By ------------- 7- Date .......... z .................. By... By...
I__ ....... Date ................ ............ --- .............
7W
MRr- Date. -1 ......
APPROVED
V ;/ .... By...
. .......................................................................................
Remarks: ................................................ .....................
.................................... .........................................................................................................
..................................................................... . .........................................................
................... ................................................................................. .........
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing C onstruction PRIOR To Request For Inspection
------------------------------------------------ ---- hereby certify that the side sewer installation constructed under this permit
Firm Perfrrming Construction)
wa."nstalled in accordance with all governing ordinances of the City of Edmonds.
Datedthis ---------------------------- day of ................................................................. 19 ---------
_j Jheck BEFORE you dig for: Water El, Gas [j, Telephone C3, Power C], Sewer E], Other N1