21733 92ND AVE W.PDFiiiiiiiiiiii
8929
21733 92ND AVE W
8 9 0 . 199 -
City of Edmonds
L T-OF-WAY CONSTRUCTION
V PERMIT Permit �umber: ?3 -
Issue Date: 2- 93
t
A. Address or Vicinity of Construction: 18502 82 Avenue West
B. Type of Work (be specific): Tnstal 1 Eft Sarvice
�4`
C. Contractor: Washington Natil. Gas Co.
Mailing Address: 815 Mercer St.Seattle, Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank 9wan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. F-1 Commercial
E] Subdivision
[:1
City Project &Utility (PUD, GTE,'�NNG, CABLE, WATER)
F� Multi -Family
E] SingleFamily
F�
Other
INSPECTOR:
INSPECTOR: Vj4j�,_4-f
F. Pavement or Concrete Cut D Yes RNo G. Size of Cut: — x H. Charge$
APPLICANT TO READ A 'GN
n 0 A
INDEMNITY. Applicant understands and by his signature to this application, agrees the Chy of Edmonds harmIqd�#vnttPMesJ&ages, or
claims of any jUnd or description whatsoever, foreseen or unforeen, that may be made d' rithe City of Edmonds, or a departments or employ
I
ees, including or not limited to the defense of any legal proceedings including defense costs, ah'd7atiomey fees by reason.of �ranting this permit.
7HE CONTRACTOR IS RESPONSIBLEFOR WORKMANSHIPAND MATERIALSFOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MAYED RESTORA77ONFEES WILL BE 1�26`UNT�L THE FINAL STREET P�TC0,3 C6M
.,PLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. .
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department
Work is to be inspected during progress and at completion. Ka4k-'eldl
Restoration is to be in accordance with City Codes. ""771-0220
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City re'g'�lations as required by the City Engineer'.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Jan. 28, 1993
Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
......... ...
.............
......................
COMMENTS. ...... RECEIPTNO:
�:�:DATE: ISSUED BY:
... ...... . . ....
NO WORK RHAIJ, RRGIN PRIOR TO PFRMIT 11,91SHA NCR
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES 0 NO
Date:
Eng. Div. July 1985
I VOI b 2- - AV
WN
Wa
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Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by:
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager qW—j(o5G
ivdrant
0 water valve
815 Mercer St. (P.O. Box 1869). Seattle. WA 98111 (206) 622-6767
8 9 0 - 1 9
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: -017
Issue Date: 3
A. Address or Vicinity of Construction: - 21733 92 Av. W.
B. Type of Work (be specific): ReDlaCe Existing Cas Service
C. Contractor: Washington Nat'l. Glas Co- -
MailingAddress: 815 Mercer St.Seattle VIn.
State License #: 96111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. F� Commercial E] Subdivision [I City Project k�xUtility (PUD, GTE, WNG, CABLE, WATER)
F� Multi-Fan-ffly EJ Single Family F] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : 0 Yes J;JNo G. Size of Cut: — x — H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the Chy of Edmonds harmlessftont injuries, damages, or
claims of anykind or description whatsoever, foreseen or unforeen, that inay be made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and atiorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
A AID A CCEP TA NCE OF THE WORK ES 77MA YED RES TORA 77ON FEES WILL BE HELD UN77L THE FINA L S TREET PA TCH IS COMPLETED B Y
CITY FORCES, A T WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application. I - '--- -- -1
A-24 hour notice is required for inspection; Please call the Engineering Department-� 771-3202-,
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature:
Date: February 2, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Enere. Div. 1991
IL
RIGHT OF WAY CONSTRUCTION PERMIT ROUTING FORM
DATE APPLICATION RECEIVED 69.,.3. ��3
WORK ADDRESS -,�/--79-5 9,�
9-�
CONTRACTOR
RECEIVED
FEB 0 3 1993
1. DATE TO PUBLIC WORKS FOR REV PUBLIC WORKS OEPT.
IV.
date5R�
,4
REV/APP BY STREET D
REV/APP BY WATER/ SEWER_&4L__date.
REV/APP BY PUBLIC WORKS_!!�� date '2
2., DATE TO ENGINEERING FOR REVIEW
REV/APP BY ENG. AID date
or
REV/APP BY ENG. INSPTR. date
3. Return to Community Services front desk
DATE PERMIT ISSU
E PERMIT # '?,5 -01Z
y
�Tu mmw qRwmrrr�o��
�TREET FILE city or Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: -017
Issue Date:
U. r) & -7,
Address or Vicinity of Construction: 21733 92 Ay. W.
N
9.0 1 9 B. Type I of Work (be specific): Replace Existing Gas Sery1ce
C. Contractor: -Washington Nat'l. Gas Co. Contact: Frank Swan
MailingAddress: 815 Mercek" St. Seattle. Mi.,' Phone: 224-2278
State License #: 96111 Liability Insurance: - Bond:* $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [_� Commercial El Subdivision F1 City Project RJXUtility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family 0 Single Family F1 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: * El Yes ��o G. Size of Cut: — x H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands a I nd by his signature to this application, agrees to hpM the Chy of Edmonds harmlessftorn injidies damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made aj�ainh the City of Edmonds, or any, of its'je�arvhents or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attorneyfees. by reason of granting this permit.
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP A AD MA TERIA LS FOR A PERIOD OF ONE YEA R FOLLO WING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORAT70N FEES WILL BE.HELD YN77L THE FINAL S77ZEET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7HE APPLICANT V
Construction drawing of proposed work required, with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departme6tow, &N-0
Work is to be inspected during progress and at completion. "771-0220
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the. City/Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior -to the e&d of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the pl�rmtt requirements�and e pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signatu�e:
Date: Fahnanly 2. 1993
(Contractor or Agent)
CALL DIAIA-DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
V71
FIELD INSPECTION NOTES (Fund I I I Route copy to Street, Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES 0 NO
Date:
Eng. Div. July 1985
Addendum to :
- - - Submitted by:
?, 1 -7 155 e Z &\,I . V4 .
JL7-:X---nKz-j c;4�
ZAq 1co-71 rA\
EDMONDS
NEW CONST.
EXISTING
WNG to window
Water main dep,
unknown
gas main
City of Edmonds
Right of Way
Permit Application
�-k �-4 C>FK'5.
Engineering Aide
Washington Natural Gas
'521"E>Z�45
"STIF
-3/4
-I+-
0 water valve
it a
815 Mercer St. (P.O. Box 1869). Sca"k, WA 98111 (206) 622-6767
I
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STREET FILE
g1ly 2f EDMONDS
PUBIJC WCM — EWjINEEPJM
ACTION REPORT
MWERNMEMEMEh�
SUSPENSE DATE:
N9 5638 ,
Date: & / ? : '-
L Time: 30 -File #
Attachments: =Yes
SUBJECT: =No
fq v-
REQUESTOR: NAME: mr!-) k-_.5tj /',(
14 v.
ADDRESS: 9
PHONE:' -7 -7 (P
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE
OTHER:
A
RECEIVED BY:
DMITE TA.
ACTION: e5j— e ADV HAS VAL V M ePg��
r1fM3K VOL-v tip- of<
All Concerned Notified
Action Completed/File
4. - 4L�;� ., ,
STREET FILE
21733 92nd
October 31, 1979
M E M 0 F 0 R R E C 0 R D
The following is a list of calls received during the
heavy rains during November of 1978 and March .1979. Some
were only for covered inlets, others for plugged drains and
creeks. During the week of October 22 to October 26, 1979
all of these addresses were checked for possible plugged
or trouble problems. Nothing was found to cause a problem.
These addresses were checked by Leadman Bill Stroud.
Bobby Dt;�I-ls
Street Foreman
�4 _'7
STREET FILE
C I T y 0 r L D M�O N D S
SEWER DEPARTMENT
STOPPAGE OF SANITARY SEWER MAIN REPORT
DATE
e
Tir"P CALL RECEIVED:
LOCAT70N
OF STOPPAGE':
ce,
TIME OF ARRIVAL ON THE JOB S17E:
TIME N*ORMAL FLOW OF SA�NITARY SEWE:,Z REESTABLISHLD:
(1AUSE OF STOPPI%GE:
T
-ACTION FE-UTRED TO CLEAR MA.N AND/OR LATEPU:
3
_,,eze' a
CT'"V CFEW 'N S70PPACE CALL 0"T (�)ezcnnei z
LOCA7TON OF RESIDENCE AF:'-T-CTED:
NAMEE, ADDRESS, AND PHONE 1-7 PROPEFTY CWNER:
,;-7
r..f_Z.
L
)ESIRTH DAMAGE To PRTVAT7 Pl�'GPERTY:
77-1k 77-1,,e e'-
REMi�.R_KS: '2
-10
9/22170.
Art
IllUi,aL 1) 1 1 t-
7111-
2.
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::assagc-:
rc,7.:
D a t e:
-72
IV-
41INTER-OFFICE COMM UWATIONS
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FROM
SUBJECT:
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C T T Y f E D M 0 N 0 S --- P U B L I C W 0 R K S D E P A R T M E N T
IDATLY VEHICLE WORK REPORT
DATE:
WEATHER'
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411
EDMCjNT�S WATEI� DEPARTMENT
Record of Water Watch Duties
ON DUTY
DATE
TIlJlE OUT p
ADDRESS AND DETAILS OF DISPATCH
TIME IN
72,
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WA C Ae fc
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CLAIM FOR DAMAGES 73
JUL 19 91
NOTICE
Claim MUST b e presen.ted to the City Council and filed with the City Clerk within 120 days
from the date of Accident or Accrual of Damages.
TO THE CITY COUNCIL OF THE CITY OF ED14ONDS:
PLEASE TAKE NOTICE, THAT ER T RZ . 11
(if married, give husband's name)
98020
WHO NOVI RESIDES AT 21733 92nd WEST,
(State present actual address by street, number and city)
AND VIHO FOR SIX MONTHS PRIOR TO DATE OF ACCIDE11T HAS RESIDED AT
21733 (92nd -T-OTCH
(Give residence by street, number and city)
CLAIMS DAMAGES OF AND FROM THE CITY OF EDMONDS IN THE SUM OF 8 61'7,-r)o -
arising out of the following circumstances:
Describe Claim, giving 21'1*�3 92nd,�.'iB`7T,
OCT. 4, 1972,
DATE and TI14E injury or THE 13!�C!L, '.,*G U.1m, O-it,
damage occurred, PLACE THE UR
and full particulars.
'GE i� 10:00 �-t n-ie- 4111B C11"
Accurately locate and t3&7" .-T --h
describe defects caus-
ing.injury or damage REORL-TIOIT
and all acts of negli- T11B CITY OP ...—&
gence claimed. Oil: TI-0 * B11 -!-1111 �.!%L) TOLD LN3 Tlil:�,2 ;101�1-'-!—��
-�T 111GET ;�r'-"
DO T" A.
TVIMT .!'-.T 8:00, 1-�E]-,T 1?1.:-! 1.'G !J.D.) ]?OR U'
1711ICH DID BUT ITODE �'-RLE TO 6---
1.2 'H-LD TO ,';Tj,,Y UP THE ElliTIRE UU111T
Accurately dercribe ThE B:4'ME .33AI-SE-70�'T PI, OOR Wj�i S' C OV 111ro TE ilL`2M
injuries or damage
BL".RLIM Fl.�D TO DO L.,;,1,Y
'NOT 'TO DO B'-,' T) Y
U Ci ED
!,T Ce .' E DURILG TILIT
State items of ddmage "'OOTER �MVICZ' 337.00,
claimed. Itemize all
expenses and losses.
3D - ;,,Y FROM 'COPK MR`. P-, 1,.T`--'--,--,�S0N' 60.00.
;A50.00,,;-L:u"j�o
V--20.00,BOX OF TOYS �20.00, BOUK3 1;..U��IC �200.00
(Claim must be sworn to by claimant)
(Signature of Claimant)
SUESCRI-BFD ANID S11'.1ORN TO
before me this ---day of
k (�N (-,J(-
NoCary Public--,inYand for the State
Washington, residinG at !E�v
T ro 7t T.Tj
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7
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NOTI. E-
w-'a'r-r a n t. y ... 0.r
N"O
The information shown on the attached
for use by the City Of
map(s) was com ' Piled
Edmonds'; its Empl.oyees and Consultants.
Th,.,e City of "Edm.onds does - not ' warrant the
these
accuracy of anything set for.th on
r entity -requesting a
map(S"). Any person o in I dependent
copyshould conduct an
]on shown- o
inquiry regarding the inf' rm'at'
tl�-e -M a P (S)Jj i n c I u d i n g, but not Hrn'ted to,
the location of any sewer stub shown. Suc
-not exist and may
sewer stubs may or may
or may not exist at the location shown.
Neitheir tihe r"ity of Edrn0n(Jq_s' nor its
em p10-yee-s o.r officers -sh-a-H be !..*,I a-b-11--e for -41-hE
n on this map(5), nor for
infor . mation g ve Ided based
any one representation prov
upon said map(s'.