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CITY OF EDMONDS Permit No.
'COMMUNITY SERVICES DEPARTMEN�
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date
Washington Natural Gas Company B. 9 Contractor:
A. 0 Owner:
Name Name
815 Mercer Stre�t
Mailing.Address Mailing Address
SiBattie WA 98111 SETAM11 lw�l St
City State. Zip ate Zip
A-& IV)
State License Nmber Telephone Numbe'r
C. *Address or Vicinity of Construction: 23304 76.Avenue West
Type of Work to be Done: Install New, Service
D. 0 Work in Connection With: El Sub or Plat 0 Single Family: 0 City Projects,
El Commercial 0 Multifamily Eg Utility
E. 0 Pavement Cut: IM Y 0 N F. 0 Size of Cut: 9 X_ 4 (1) @ 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 kirk,.T t, gs Arpon wh ' 0 foUeSn or unforseen, that may
be made against the City of Edmonds, or any of its depa"r rzw_r� pIoye2/i—h7ukn7g W d6t limited to the defense
!f OS
of any legal proceedings including defense costs, court c6stva"rid attorney fees by reason of granting this permit.
C
THE CONTRACTOR IS RESPONSIBLE FOR WOR NSHI� AND �;TMALS 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 I is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected, during progress and atcompl6tion.'
• Restoration to rbe in accordance with City Code.
e Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be paiched withr 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 8, 1990
Owner.or Contractor
'This Permit Must be Posted at the. Job Site For Inspection' Purposes
Call -DIAL-A-rDIG Prior to Beginning Work.
APPROVED BY: . Rw
Time Authorized: Void after days.
Special Conditions:
PERMIT FEE: --*,30 t�o- /20 ZL/-
Restoration Fee:
Receipt No.: —
Fund 111 Fee:
Street Cut Dimensions: x_ $
RELEASEb-B Date.//-,/"/) INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept*)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES 0 NO
Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh�
Washington Natural Gas
622-6767 x 2588
4A-eeP- MAIN vaFn+
Ur-4 Wj1iOW&4
C-)(I 5-ri K4(st 4 -4 # C-3AS
PFbPC6E0 —
KEY:
-ss- sanitary sewer
-s- storms
-w- water
1 0 water valve
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).
CIVIre CITY OF EDMOMDS
CENTER WATER-S-EWER DIEPART'N
SME SEWER MMIT
Pli-sPect 0-1107 Wh" . Work
IS ready for b211eM
t1ons Saturday, Sun an- (NO Inspec-
day Or handays.)
APDRESS .....
............................................... 240!�
OWIVIER --- Zfthm..
----------
Per"ssfoll at-k.o .... 7" ............................... n ..... .......................... .................................
witi, Ci 's granted ...-De.cembe CONTRACTOR ...
,r 10_ ...... OWMer
tY Sewers 'n accordance it, ... ........... 19 ... ra4 for .................................................. .
ATTENTION IS applicat'on OD file and ---------------------- da I
NOTE; No. CA1,LI3D To governing YS to REPA-M or CONN-ECT a
I—Th TRE ZOLLoWING: ordinances. side sewer
b. :,,�—S'- Of the property ,
".Yed aY obtain at Permit to co
NOTE XO.'2--,Ok)t.l. full 'to construct Side sewer in stre,
NOTE No. 3--�V "orniatiOn r area. nstruct sewer Inside Property 11
egarding Do not Cover any Portion
Top Of Side sewer in ordinance 11.,6.0,0 and ZioreAltilcensed Side Sewer Contract
beads in Ust have at least 30 Of sewer
NOTE; No. hes grade sharper than % rage a Itegulations has been Inspected. Or must
4—Trenc Inches cove governing side Sewers When you
failure du In street will be Pernlitted. I Property line and 12 inches get Perrnit.
e to jznp "lust be Water settled and Inside property
I No. &—it is unlawful roper work
Which May dcveB.Urf&ce Of street restored to line;
to alter or do an other Year orf.9.1nal condition.
Purtenances except to Insert they P Within One 10 . raluImula gradO Of 2%.
work than Is Provided for in the Perrnit, or to do an Ors shall be responsible for
Pipe into the Wye. of "'Pie Contract
Y Work on the Main sews�r or its ap_
APPLICATIO N CARD No - ----------------------
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FILL
for
/Xivy of Edmonds S1JDE SEWER PERIMT
EASEMENT No . ...............
............. ..........
OUTSIDE El INSIDE E] REPAIRS
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1p, ),fd PERMITN
OWNERi-/ ------- 2 - — ------ ----- ------------ ....... ...... CONTR.--,..; ------------------------------ .. . ...............................................
STREET
No . ........................................................................ BLOCK No . ............... \ --------- --------------------
AVENUE LOT
HOUSENo . ........... &Z ----------------- ---------- ------- ......
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NAME ADD . ....... ..... ------
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