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Cl-If -OF EDMONDS P Permit No.
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY cbNSTRUCTIONPERMIT /V 0 C Issue Date
A. 9 Owner: Washizigton Natural Gas Com-pany B. ontractoSTREETR��
Name
NO Mercer Street
�,WU%1%dd,ess WA 98111 Mailing Address
City State Zip
City State Zip
State License Number Telephone Number
C. * Address or Vicinity of Construction: 21926 97 Avenue West
Type of Work to be Done: Install New Service -
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
0 Commercial 0 Multifamily EX Utility
E. 0 Pavement Cut: 19 Y [IN F. * size of cut: 2 X 4 @ 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 kind or description whatsoever; fors6en or unforseen, that may
be made against the City of Edmonds, or any of its dep; W In
A,?,0nploJ96s/ii?cIud;'v1@r,6r not limited to the defense
of any legal proceedings including defense costs, court c6s6s, and attorpey fees,by reason of granting this permit.
Pi's
THE CONTRACTOR IS RESPONSIBLE FOR WORIKMANSHiP 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 hour notice 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 beln 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: November 2, 1990
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: &�i .�
Time Authorized: Void after —
Special Conditions: Y 4
RELEASED BY
PERMIT FEE: 30-00
Restoratiog Fee. 40-
0 15 (Z %0 PT% C _0
Receipt No.:
Fund 11.1 Fee:
Street Cut Dimensions: x $
Date INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Date
Frig. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street DVt.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
Nattu-M Permit Application
AVVhftxjbon&-WCaq-V Engineering Aide: Kerry Walsh
Washington Natural Gas
U') 622-6767 x2761
proposed
Key:
:s- savLitary sewer
w- water
-g- gas
water valve
hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
x APPLICATION
for
The City of Edmonds SEDE SEWER PERMT
NEW CONSTRUCTION C] REPAIRS 0 EASEMENT No . ..........................................
inq-nS400
OV*rNER, ............ Ha.r.old --- E.'...'Je.well ......................................................... CONTRACTOR ................................................................
.. . .... F ..... . . ---------------------------------- PERMIT No . ......................
ADDRESS ....... 21.92�...-.! ... 9.71h .. Aye ...... W . . .............................................
cl
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ................. ....................................................