22821 76TH AVE W.PDF111111111111
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22821 76TH AVE W
CITY OF EDMONDS Ir
PUBLIC WORKS DEPARTMENT 8TRD Eff RLE
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or v icinity of Construction
22821 76 AV W P lat 166-070,003
0 Owner: Washington Natural Gas Co
Name
805 156 AV NE
Mailing Address -
Bellevue, Washington 98007
City, State, Zip Code
Contractor: Same As Above
Name
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krrnit No. 0
Issue Date �/— e(9
9 Permit Issued To:
9 Type of Work to be Done: Install New Service
0 Work in Connection With:
11 Sub or Plat E� Single Family
11 Comml. / Ind. El Apt. Condo.
0 Pavement Cut: El Yes El No
Mailing Address State License Number
Z
< City, State, Zip Code Telephone Number
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0. NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
14, from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
tj against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
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Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
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Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this pe'rmi u be avail le a t.
aN
Signature:— =%_&
Owner or Aud'
for inspection purposes at all times.
te 2/6/80
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: I - L t / 6( 4
Time Authorized: Void after 3 0 —days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the 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 Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION CARD No . ............. .........................
A for
The City of Edmonds SIDE SEWER PERMIT
1416 S U/0 147-14( EASEMENT No. ---- 7 ..... ..
TSIDE 0 INSIDE 0 REPAIRS 0
Z' Q J Qf 6 7 1`6
4.c � . ....... ..................... PERMIT No�, ......
OWNER ...... nf&.j2 ......... Ne.1.1.6WICE ....... eS . . . . . .................. CONTRACTOR 'Ovs� .......
STREET
HOUSE No. .............. V .................. ............. AVENUE LOT No . ........ .................. ................. BLOCK No. ..... ......... ... .................
..... ....................................... ...........
NAME ADD
7S-
—A,
OL OCK S/- 000,
1-97-
LO
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0
I-VAMAAACK
)31
Date
BACKFILL WORK ORDER ISSUED ........................................... DEPOSIT, $ ..................
SEWER WORK ORDER ISSUED .... ............ ..............................
Approved:
DATE.
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APPROVED
0 13, 8'z
.. ..... ...... By.... .... . ..............