22034 98TH PL W.PDFlill iiiiiiii
9747
22034 98TH PL W
d 9 0 - 1.9 4 -
ity of Edmonds
'ST%R1f_0_WAY CONSTRUCTION
Y Permit Number:
Issue Date:
4�ko
—6
A Address or Vicinity of Construction:
B. Type of Work (be specific): f�,Vr, C-E� 12 10 CIA hne k \.t
C. Contractor: Wa - M i Go -3 Co
Mailing Address: 81 -Ole r cc y- _�-t -
State License #: wa -s v\ qe>lk
D. Building Permit # (if applicable):
Contact: V-jz A," �z
0_1
Phone: -Z--2- -7 S
Liability Insurance: Bond' $
Side Sewer Permit # (if applicable):
E. TJ Commercial 0 Subdivision [I City Project Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family Single.Family n Other
INSPECTOR: INSPECTOR: W�J�
F. Pavement or Concrete Cut PY"e's E]No G. Size of Cut: x 41 H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmles§'from injuries, damages, or
claims of any kind or'description whatsoever, foreseen or unforeen, that may 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 attorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ArD MA 7ERIALS FOR A PERIOD OF ONE YEAR FOL�O WING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL S7REET PATCH IS COMPLETED BY
C17Y 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 Departm
Work is to beinspected during progress and at completion.
771-02i'a''
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:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
SHALL BEGIN PRIOR TO PERMIT
Engrg. Div. 1991
i
FIELD INSPECTION NOTES Fund I I I Route copy to Street
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES
Doe:
Date:
0 NO
- I
r-fig. UIV. Jilly 170i
NEW SERVICE PRE -INSPECTION REPORT
WNG 836.8 S
SERVICE ADDRESS
DATE GAS REQUIRED
p
EX. STUB
LOC.
NO. EX. STUB
FOOTAGE REQUIRED
CONDITIONS
METHOD
STUB
CONC
PS
PUNCH
INSERT W/CU OR ST
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 TRULE (RES)
METER
CHANGE VISA 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
PLOW
SOD CUTTER
COPPER PULLING EQUIPMENT
REMARKS & SKETCH:
cl.i_
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c)
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C)
PRE -INSPECTION BY
DATE
APPLICATION
P, L
--,4 for
The City of Edmon s E SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION F] REPAIRS 0
400-05600
OWNER----------- Har.ry ... Chi-s-halm ............................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... �?03.4.'- .9-8-th .... P.l.a.ce ... W ................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
..... .. . .. .. .... .. . .. ....
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................