21904 82ND PL W.PDF111111111111
7683
21904 82ND PL W
Wt .44,
V -V
C4Y of Edtitonds Permit No:
RIGHT—OVI;�WA,Y"""CONSTRUCTION PERMIT issue Date:,
r I . /I ! I ILX/ -,
A. Address or Vicinity of Construction: Z_ L
of Work (be vn' �c& )1 a, k 'vA Cs
B. Type specific):
7111, 10 -7 01 994 1
L R Z_ 9L �L_t Y
C) LQ_
00 Contact:
C. Contractor: J� U - I C, 1"" / Po,—H-,
Mailing Address: �C)),�c TO k) Phone: 0-16 -41 4,�, (3 f C,)o C,
State License #:- L C I Q ( 111 Liability Insurance: Bond:$
City Business License #:
D.
Building Permit # (if applicable):
Side Sewer Permit #�ifapplicab�e):
E.
F1 Commercial
Subdivisiop,,,',
Project- F - EVC (POD"- VEAMON;fSE, COMCAST 0 VWSD)
_E].-.�_'ity
F-1 'Multi -Family E]
SingleFamily
El Other
INSPECTOR:
F.
PAVEMENT CUT: W YES
El NO
G. 'SIZE OF CUT x
CONCRETE CUT: [__1 YES
F-1 NO
G;-
El Mail Approved Permit
Call for Pickup
APPLICANT
TO READ AND SIGN
INDEMNITY.- Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting 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.
+ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance with City codes. All street -cut trench work shall'be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
+ Three sets of construction drawings of proposed work are required with the permit application.
i
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATI MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: Date: lao
(Contractor or Agent)
'FOR, CITY USE ONLY
Approved by: LAd Right-0--way-FeeiA.U.0
T m ,Fee/Vund-,` 11'
i e Authorized: Void,After T
Special Conditions:. AAAW 10 Inspection-Fee:_A' W-pt—
!Wrw Store. OF s�o-k '6 e8g_� f1bl, P.VAS 01 Total Fee: *qll Swel-
VMV4,1 ak" 4 CLOHL, 0", 6go-C,61 M6. M J� p�
5' fth� COW WAL414;ks �JATJN ftgj�f, Issue-d"'b'y',
ffidfLIQ 00
& 995t� a 9AA1,M0, #A_&(4'4F "4
C,
t*wtyslftyg� -TO IJI�Z a- $r8JJ?:9= WtJ
. a"'
REQUIRED INSPECTIONS: c awym, -
Call 425-771-0220, Ext. 1326for a 24-hour voice-recorde� inspection request line.
FINAL APPROVAL OF PERMITTED WORK: 7'�A,'
's Sig,,
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
CADocurnents and Settings\CunisNy Documents\Fomis\Engnrng\ROWpermit_.doc Revised 1 0101103
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)INOM
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0.
Nyl ]No
VL-02 I"
INJ
28'
4 PTViG1-
Z-1
EL
NOT TO
SCALE
C%I
Go
20 ST SW
Notes:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is e/o c/I 82 PL W
3. Flaggers will control alternating
one-way traffic.
4. Alert affected residents
5. Channelizing devices are 28" cones.
6. Tapers will be 50' - 100' and must
contain at least 6 devices.
7. All signs are 48" x 48" B/O
unless otherwise specified.
I CHANNIELIZING DEVICE SPACING (FEET)
[TA—P-ER-F TANd—ENT
20�
_1�
C0
0
0
0
. 'go
U�
, 3:
2 wo — 220 ST SW
2 200'
LEGEND
tz WORK AREA
�00 0
x J. I
00 Pilchuck Contractors, Inc. 28'TRAFFIC CONE
Job #107018941 EXISTING TRAFFIC FLOW
:E
r\) 19 Jan 04 'SZ SIGN LOCATION
0 4 May 04 i-
Sheet 1 11 FLAGGING STATION
0 J. Buss PROTECTIVE VEHICLE
National Barricade Co ORWORKVEHICLE
Notes:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is 15'w/o c/I 82 PL W
3. Alert affected residents
4. Channelizing devices are 28" cones.
5. All signs are 48" x 48" B/O
unless otherwise specified.
6. Maintain a 10' e/b lane on 220 ST SW
ry
0
(11ozy-
N 0
SCALE
Id An, 220 ST SW
150' -.1' 150'
0
Pilchuck Contractors, Inc.
Job #107018941
19 Jan 04
Sheet 1 / 1
J. Buss
National Barricade Co
CHANNELIZING DEVICE SPACING (FEET)
TAPER
TANGENT
20
20
I LEGEND I
WORK AREA
28" TRAFFIC CONE
--0- EXISTING TRAFFIC FLO"
NZ SIGN LOCATION
PROTECTIVE VEHICLE
9919 ORWORKVEHICLE
CROSS SECTION A -A
NOT TO SCALE
60' R/W
30, 30'
14' 14,
PAVING PAVING
EX. WATER PROPOSED 2" GAS MAIN
15-E CA
—IP MAIN
!PROPOSED 2" MPE
15-E CA
E CA
A
220 ST SW
9' CAM
—rt— 60' R/W
EX. 2" STWIP 21'S
5. SOLW-
1962 J-3747D
2" SERv10E TEE
TAWRE
& BOX
21 'S, 15'E
CA
____'S -
------ E CA
2" TRANSIT10N
FITTING
20-So 15-E
CA
S -
------ E CA
STANDARD, GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL NONE —CALL" TWO WORKING DAYS PRIOR TO CONSTRUCTION, IN
WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iS1 TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS ISNTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550-1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
5. ANY CHANGE IN ROUTE. TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY PSE GAS ENGINEERING
SERVICES.
6. COMPLETE "PIPE CONDITION REPORT"ON ALL EXPOSED EXISTING PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
T. ACTIVE SERVICES DENOTED BY:
B. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525-2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HP VALVES IF THE LOCATION IS NOT:REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE
PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTE MS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ONTHIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES.
11. SYSTEM MAOP DENOTED BY:JSYSTEM MADP = 45 PSIG
12..GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
1 3-RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED. (USE MANOMETER FOR
LP SYSTEMS)
15. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER PONDITJON.
16. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3400, AND 2525..1200.
17. COORDINATE INSTALLATION WITH CP TECHNICIAN ED VOOGT @206-396-2799.
F-SITE
FITTER (Check Box if Complete)
• WORK AREA LEFT IN CLEANISAFF CONDITION.
• COMPLETE ALL PIPE TABLES AND GAS PRESSURE STAMP.
• FIELD CHANGES RED —LINED ON AS—BUILTS.
• MATERIAL VERIFIED AND CHANGE3 NOTED ON PAPERWORK. 1:1
e ALL VALVE AND TIE—IN LOCATIOUS NOTED ON AS —BUILT. 0
• NOTE BEGINNING OF MAIN, EOM,8 LINE OF MAIN LOCATIONS. 0
• SHOW ROPE LOCATIONS & CUL—EIE—SAC RADIUS 1:1
Fitter's Signature
Company Employee ID#
GAS MAIN INSTALLATION/RETIREMENT
TypeNVork
Pipe
Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
2"
MPE(SCAT)
300'
GAS MAIN PRESSURE
& TESTING
TYPE TESTF
T I MIL ON
TESTED BY
__JffE�SLRE
DAIE LN
DATE OFF
T IME OFF
TYPE TEST
PRESSURE
TESTED BY
TIME ON
DATE OFF
IDesign
TIME OFF
Press 60
SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER#
V)
0
I
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg./FT
HIP Svc/MSA
Relocate
lRetirement
X045214957
107018941
X181149160
106122576
X445193227
X39765103i
X516196053
Owner / Developer Contact Info
DONALD STUDZINSKJ
21904 82 PL W
EDMONDS, WA 98026
ATTN: nr)MAI n (ZTHr)71N.4ZVI 425 76-8771 OfficB
0
4
Contractor: CONSTRUCTION COST CODES:
031-103-1
REVISED
Project Manager Contact Information:
CALL (800) 424-5555
2 BUS INESS
DAYS BEFORE YOU DIG
(2�
PATTINESS
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATIONOF FACILITIES
CELL: 425-327-2783
0
REAL ESTATE/EASEMENT
PERMIT
L
CSEA
EDMONDS
RE\/#
DATE
BY
DESCRIPTION
FUNCTION
CONTACT
PHONE
DATE
rn
3
P ROJECT MGR
PATTI NESS
206-418-4237
2
ENGR — GAS
I
DRAWN BY
PHUONG DAO
206-418-4218
1/5/04
CHECKED BY
PATTI NE SS
206-418-4237
COUNTY
EMER SECT
GAS
WK CTR
APPROVED BY
PATTI NESS
206-418-4237
k� kq -CY-
SNOHOMISH
5
MNSNHG
FITTER #1
1/4 SEC
OP MAP
PLAT
MAP
FITTER #2
SE 30-27-04
164-068
164-069
JOINT FACILITIES ARRANGEMENTS
UTILITIES
U
CONTACT
PHONE#
SAP Superior Order:
PUGET
2 MPE-IP MAIN EXT.
107018941
"Zr
(=
SOUND
Drawing Number:
ENERGY
21904 82 PL W. EDMONDS, WA 98026
N/A
(STUDZINSKI)
SCALE*
AGE:
ON.
DESIGNED BY PILCHUCK CONTRACTORS INC.
50'
1/1
0
NOTICE:
Nb--�karranty ... 0 T. a� U (' U I d �_.Y...
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e City of �Edm.qnds does not . warrant the
accuracy of anything set for.th on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
-t-Fe -m a p (s) , including, but not I'mited 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 Edmo'nds nor its
ernp-to-yee-s o-r office-rs -shal-1 be 111a.b.-Ife for the
information given on this map(s), nor for
ion provided based
any one representat'
upon . said map(s).
.p
KET FILE
APPLICATION
for
The City of Edmonds
SIDE SEWER PERNUT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
OVVNER C�<Dt--A ..........................................................................................
-T
CONTRACTOR ............. E-...E= . ... ..... E ....
............... PERMIT No . .. ...................
ADDRESS
. ............ F=L .......... W ....... ....
LEGAL DESCRIPTION: LOT No . ..............................................
BLOCK No . ......... ..................................
NAME OF ADDITION .... . . 14 ........... t-� ..............
........ ;:r ....... ..................
0
7��T
1�31r
DATE.... ............ By ...........
7-
z
'M -SIDEt'ISEWER) PER) MN, IT
UTY OF: ED1,010H "S,
SEWEIC DEPARTMENT�.
IRIMIV, A,; iV
j
� al�,�'17,7`5-215�25i for, iside, sewer. Jnsp��etionsl BFFORE coveringt-:ai4y,�*,portl bfii�of' -thei C;nst ti,
c �,uc
inspectlons.
th pkflon� will' be, provided, wltlil�;;2� h6uis�laffer regust: O�,,Sat., �s iof �hollday -
qn.
82nd,Place. eSt
A,DDRESS`iGC kl'-TON 6F C ONST-RU, cT10N-_..*.`.1 .............. .................... ; .......................
.............................................. . ........... ........ ..................
PiAriti a nn t
-PROPERTY,'*iL-EG�A�Ll,,DES'CRI'PT-9[iDN .......................... A ........................... ........ Pa No
......... ................................................................... ...............
. ....................................................................... ........ ......................... ............................... ......................................................... .............................................................
................. . .. .......... !0, ER,�,D/0R`,,BU1 11MER
.......... ..................... ............................. ......................................................
..... Kexmarp-.�,
,C0NTWACT-0R',&,'NA,MK,'& ADDRESS E i :'Bkhtol d to. P.,O a6x
........................................ I .......... ... ... . ..... .................... I ....... 7: ... 7 ...........
A.P.M.-I ... 18 ..................... 1,9 ... 7.4 -,connection of:,a -side sewer� to thet city,sanitarSr 'sewer
Perinissibn,A&gran - ted . ........ ......... S for repair and/or
sy,st-M, in accordancemith, C1ty%6ft'EdxA ond§. ordinances.
AIT,,,TIOM I&CkLLED, TO) THWFOLLOWING:
NOTE!,No; !—T.fie;�oAVriers',of';the,.�p�opertyi'm�L;�'o�tain'..&�perniit'�to;.6o�s�ru'et,,sewer Inside�,p`ropertytIInei k licensed, Side��Sew'er�zConfractor��must,lb,e,employedi.,to,i construe
tslde'fsewer-An street. area., hi�', n6t;cover.any,portlon �of `seWer,'ibef6relt �ha&beenl;ldspectedl..
NOTE;Not. �2'�,Wlli'Nyork�.�performed'iri- (city -�equtrest ani.Invas ow,of �Right-of-Wity.,Pelrmii.,o�ta�hable from the,,City, Engineer' s, offlee�
WOTE��Not ��'bbtath,,full�,itiformati'on'llregardiilg Ordlnanee� I.T.M036 arid,'Regulations. governlnk,igii]6��sewirs, whem,you, get permit.
NOTE, No. 4--:-Top.�of side;, sewer must, have At I , east. 30.inches, co.verageAt., property. line and 11 Inches Jinside,property iln6' �'Mii�lmum,,grade.-of 2,0%. Nwibends,,in,grade
sharper,Ahi� % will' be -permitted.
NOTE No. LS--Trenches! In; streef,must be. water settled;,andl;sur I fa�CePof. stieet,ieitoredl n'to origina 11�condltlon,. Contractors shall, be responsible for� fallun,due;,to,. Improper*
work1which; mak develop within,one year -,of completion.
NOTE'No. 4�1t.,is,kunI . awful, to -alter :or dc�,any- other work, th�n-'Is providi - d for in the. permft-�,,or_liol d'o, E�ny, 'Work,on-the, main-'sewer.�or�-tts,&ppurtenarice�,:except -to in-
Mert. the,�pipe. Into, the wye.
A)ISAPPRCI,-�/EIX:�'E31 Date ...... w'.*o'.�.': ....... . A.
.............. Date! ........ �zj ....... .... . ............ . .................
Y, ................
AP,
APPROVEO)' Datei.: "BY.7. ........ . ........ ....... .......... ......... ..........................
Robinarks'v ....................... .. . ... ...............
................................................ ........ ....................... ........... .............................. ............................................
....................................................................... ...... * .............. -------- ........................................ : ............... ....... .............................. 7— .......... .... .............. : ....................
rf ormbig,, , C6nstructibn.,PR1QR, To, Request For lnsp
B 0 T H�i,`,,.P�, e rT C MU ST—Be Sigped' By I �, inteof P) Pe ecti6nt-
1""'I'OPI
.9HA opie
ce ft
'4s� aii6n����nst-ructedl�uhder'th'
. .........
......... .. ....... ...... . _-�1_,-he�eb tify�thal�!t e,;si',er,�ewer n till
YL mpermi,
(0,mn e 7 M, I erforming- Cbnstructlbn)'1'�
.1 ntracting
dan o4ds�
Ab all.,governing, ordinali(es�bfAhe.,City of"Edmon
wa— istaiiedtfik;a.c.cor ce, wJ. d
Dated this ... .. ... ...... .................. .............
. . . .......... (Jay 1:�
f
e E9 4 V,
(Check BEFORK- yout dig for,:, Wat r -E],,. Tele�honp�IE] Power::E]".� �bwer. ![3, qther, 1 1
APPLICATION
for
The City of Edmonds SME SEWER PMMT EASEMENT No.
NEW CONSTRUCTION [] REPAIRS 0 /-
genelro & 0
4(/- z J /v 2� .........
OWNER ... P ............ ------------ ............................ ----------------------- CONTRACTOR ..... f� . ........... ......................................... .... ..... PERMIT No.44.%33
............................. ....
ADDRES ..................... w e
S .......... ----- LEGAL DESCRIPTION: LOT No . .......... / ...... ......................... BLOCK No . ............................................
NAME OF ADDITION ... .......... ......................... > ....................
P(
a-ppruveu;
RECEIVED
APR 18 1974
DATE................................................ By .............