22005 99TH PL W.PDFlill iiiiiiii
9768
22005 99TH PL W
APPLICATION
for
SIDE SEWER PERMT EASEMENT No . ..........................................
-NE REPAIRS 0
ONSTRUCTION
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"T F1,
The City of Edmonds
400-06100
owNER........... H-a-lbe ... B.....An-de.rs.on .......................... ------------------------ CONTRACTOR ......... ........................................................................................ PERMIT No . ......................
ADDRESS ------- 22005 99th Place W.
..................... ........ ............................. ..................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
E
NAMEOF ADDITION ....................................... ........................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
-7- -- 7
City of Edmonds -
RIGHT -OF -WAY CONSTRUCTION
PERMIT Permit Number. X
STREET FILE
Issue Date:
A. Address or Vicinity of Construction: '22005 99 Pl W
9 0 1 9 C� Q� B- Type ) of Work (be specific): Service Renewal CONFIRMING PERMIT
(Work was done last summer)
C. Contractor: Waghingiban Nattiral Gas Company, Contact: Frank Swan
MailingAddress: R15 Mprnp-r qt, Seattle, WA Phone: 77A-777A
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision 0 Ciiy Project [N Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family E) Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 94Yes []No G. Size of Cut: 1 (2 x44) H. ChargiE�,$
In Asphalt
APPLICANT TO READ AND,SIGN
INDEMNITY.'Applicant understands and by his signature to this application, agrees to h1d91h'q.00ity ofEdmonds i��mages, 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 or not limited to the defense ofany legal proceedings including defense co�is, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALSFOR A PERIOD OF ONE YEAR-FOL'LOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK ESTIMA TED RESTORA T10k,-,Fk.-§,WVL BE HELD UNTIL TlIkF&Ai 4VREET PA TCH
IS COMPLETED BYCITYFORCES, AT WHICH TIME A DEBITOR CREDIT WILL BEPROCESSEDFOR ISSUANCE TO THEAPPLICANT.
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.,
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.
Ihaue read the above statements and understand thepermit requirements andthepink copyof thepermit willbe
available on site at all-67files for inspection purposes.
Signature: Date: March 14, 1994
(Contractor or Age�nt)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPRO VED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER J'40 I I DAYS
SPECIAL',,CONDITIONS:
COMMENTS:
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
I
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Nv. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Cohiments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Nabjr5l
AW&ftVcnbWWC_V&V
WNG to window
Water main depth
unknown
11 gas main
Addendum to : City of Edmonds
Right of Way
Permit Application
--- Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
C-0,UFIAM1,VG -Per lzn , r
1,1��oo_ ::5�,catftctz 1Z1z"xw,4(_
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2,ACj- 4 �5 /4'- C U T
WO&C POAJ4- 41457'
J- 0 M a7 Ir/L
-w-
water
-g-
gas -
-ss-
sewer
-i&-
water hydrant
0
water valve
815 Mercer St. (P.O. Box 1869), Scank, WA 98111 (206) 6Z2-6767
L
'Cit of -Edinbnds
.1 y
TfM-WAY CONSTRUCTION
R
y Permit Number:
Wue.Date:
A. Address or:Vicinity of Construction:
B. Type of Work (be specific):
(9 9 0 1 9 C� C�)
C. Contractor: (a a" o. ti cL -5 Contact: J�'-(gp,�rgg, r=t,3A,-kt
Mailing Address:. 61S -We r cc, e :,C- cL-- Phone:
-72 -7 A
State License #: Locsv-� 4e)�k t Liability Insurance: Bond' $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. El Commercial El. Subdivision City Project Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR: W4,
F. Pavement or Concrete Cut MY 'es ONo G. Size of Cut: -.?— x 4t H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlesrfivin injuries, damages, or
claims of any A ind ordes&iption whatsoever, foreseen or unforeen, that may be made against the CRy 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 attorneyfees by reason of granting this permit.
THE C0N7RA CTOR IS RESPONSIBLE FOR WORMANSHIP A AD MA TERIALS FOR A PER[OD OF ONE YEAR FOLLO WNG THE FINAL INSPECITON
AND ACCEPTANCE OF THE WORK ES77MA TED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
C77YFORCES, AT WHICH 77MEA 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 Departmek'
Work is to be inspected during progress and at completion. lop. -1 -0
220
Restoration is to be in accordance with City Codes. 771.0
Street shall be kept dean 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 req uirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY: RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER. 1061 154- DAYS DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: JtJ, elEtb4trJ VA/OPrt-
12, 5vcti ProArrJ
COMMENTS:
RESTORATION FEE:
PERMITTEE:.,
TOTAL FEE:
RECEIPT NO:
— DATE: — ISSUED BY:
NO WORK SHALL BEGIN
V--- ";- 1601
NEW SERVICE PRE -INSPECTION REPORT PAa
�., , I fl-4- ll.-� c
WNG 836.8 S
SrRVICE ADDRESS
DATE GAS REQUIRED
99 P(-
EX. STUB
LOC.
NO. EX. STUB
FOOTAGE REQUIRED
CONDITIONS
METHOD.
STUB
CONC
PS
PUNCH
INSERT W/CU OR ST
I
SOD
DIRT
OPEN TRENCH
EX. SERV
INSERT W/CU
W/ST
NO. EX SERV
FOOTAGE REQUIRED
TWIN
SERVICE
CONDITIONS
METHOD
CONC
SOD
DIRT
PUNCH
INSERT
ROCKERY
GARDEN
PLOW
OPEN TRENCH
D-4 CALLED FOR LOC. OK'D
EXCESS OF 3' RULE (RES)
METER
CHANGE MSA
LOC.
CUST. VERIFIED MSA CHANGE
& ETC.
SALES NOTIFIED OF MSA CHANGE
EXCESS WAIVED
BACKHOE
BOARD& IRONS
EXTRA CONES
EQUIP.
NO PARK BARRICADES
METER HOODS
BORE MACHINE
PLO
SOD CUTTER
COPPER PULLING EQUIPMENT
REMARKS &-FAXETCH�
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PRE -INSPECTION BY
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