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23606 76TH PL SW
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431.
RIGHT-OF-WAY(CONSTRUCTION
PERMIT Permit Number:
..... ...... Issue Date:
A. Address or Vicinity of Construction: 18921 84 AV W (9526742)
9 B. Typ-6\of Work (be specific): Install Servfte
C. Contractor: - WaShingt" NatUra]L a Contact: FraSk Swan
Mailing Address: 1122 75 St SW Everetv" Phone: 447-3284
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial [J Subdivision El City Project Q1 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: EkYes 0No G. Size of Cut: X-) H. Chargq_$
iON
APPLICANT TO READ AD SY-Lut
INDEMNITY: Applicant understands and by his signature to this application, agra�`sto the City ofEdmonds harmless fi�onkini . urie damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may ainst the City of EdmonWJ6' Wylaf its d
r Wtments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ol�rantirrg thispermit.
In 11 41 -
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FLL20kN_d�T_H_E FINAL
INSPECTION AND A CCEPTANCE OF THE - 4011K. g�,TWTED,RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH
is COMPLETED BY CITY FORCES, AT WHICH T134EA DEBIT OR C'REBYT WILL BkPh'dC99SED FOR 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.
Tr-affic 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.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at'dll inspection purposes.
�time�
Signature: 4o n- t-r a-c to r o r Aiin if Date:
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY. USE ONLY
APPROVED BY: k AA-, tl RIGHT OF WAY DEPOSIT..
TIME '. A . UTHORIZ E13r VOID AFTER' 12&-_!5 �DAYS DISRUPTION FEE/FUND 11 . 1:
SPECIAL CONDITIONS: SA tj a AY 5.Kw F- r*t.— RESTORATION FEE:
-PERMITFEE: 0
TOTAL FEE:
COMMENTS: 4-- 52 >-2211101 RECEIP T FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMITJSSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
13 YES
Date:
Date:
11 NO
Natur5lGw
A%&bVwVtcn Energy Company
Av w
Watermain depth. Kj,/�
2- " gas main
3
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Harlawne Kingsbury
Migineering Aide
Washington Natural Gas
0356-7500 X7596
Key:
-G-
-SS-
0
Water
Gas
Sever
Water hydrant
Water valve
Washington Natural Gas Company
1122 75th Street SX. Everett. Washington 98203. (206) .155-3331
Natur5lGw
AV&fAnglon Efergy C-V&V
W
CA)T
(eq,,? 1 6 4 AY
Watermain depth
Z- - gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
Key:
-w- Water
-G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
, Washington Natural Gas Company
1122 75th Strcet S.W., Evcrett. Washington 98203, (206).355-3331
1%k A "Peann
.00%" 1 ��
NaturW�Gas=�—
AWaftxjbnEroWG-rtwV
(eQ ez 4 4,,VV/ V\J
Watermain depth KJ/4,b,
2.- " gas main
I
Ad dendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariawne Kingsbury
Ligineering Aide
Washington.Natural Gas
1356-7500 X7596
Key:
-w- Water
-G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W.. Everett. Washington 98203. (206) 355-3331
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City off.Edmonds
RIGHT-OF-W ONSTRUCTION
PERMIT
Permit Number.
Usue Date:
A. Address or Vicinity of Construction:, 2-3606 76 Rl V 9510105
C) lz� B. Type of Work (be specific): Install 2" Plastic Gas Main in 76 Pl V
9 0.- 19 from +— 2071E c/I 78 Av V' to +— 181E c/l 76 Pl V also install 1-1/4"
Plastic Gas Main in 76 P1 W 1roz.,+— 19-M c1I to 75515 cil 236 St Sw
C. Contractor: WashJUgton Natural Gas Contact: Fr,�nk Swqn
Mailing Address: 1122 75 St SW Eye-xett Phone: 447-3284
State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. (-] Commercial EJ Subdivision 0 City Project [:J Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family Single Family El - Other
INSPECTOR: 114SPECTOR: I-Alk; 4--1*1
F. Pavement or Concrete Cut: RkYes []No G. Size of Cut: — 41 I/x 21 H. Chargq�,$
APPLICANT TO READ ANDAN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any �( its depar_tments or
f ?
employees, including or not limited to the defense of any legalproceedings including def4#t—s"sfs,.and attorney fees by reajCd"j�-"ti,*�W8 permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR 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.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times fo *nspection purposes;
Signature: Date: 8-22-95
wo?(Am or _Aie7nt
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE, ONLY
APPROVE D BY:
TIME A1JTHOR1 ZED: VOID AFTER 4)n %J DAYS
SPECIAL CONDITIONS:.
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATIONYEE:
PER MIT FEE: -
TOTAL FEE: 30 00
COMMENTS: RECEIPT FEE:
DATE:. BY:
V
r
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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ITEM QUANT DESCRIPTION STOCK NO.
BILL OF MATERIAL
PERMITS: Ef.:�mc)mr-YS, 1/4 SEC:
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ITEM QUANT DESCRIPTION STOCK NO.
BILL OF MATERIAL
PERMITS: E [,-M o �,A D�:—> 1/4 SEC:
PLAT:
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TAX CODE:
SEQ. NO:
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:�5, CUTS 1�,A FAVIKG AP-E.S�\CTAJ�Q /\-S
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The City of Edm
APPLICATION
for
ETFILM SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS
OWNER --- MUF�,---rL - ------
JOB ADDRESS F.-t-
EASEMENT NO - --------------------------------------------
LID NO - ------------------ ASMT. NO - ------------------
CONTRACTOR ------
----------- ---------------- I ------- ------------------------------ PERMIT NO.
LEGAL DESCRIPTION: LOT NO - --------- C�
- ---------------- ------ BLOCK NO - --------------------
------------------------------------------------------------------------------------------------------ ------------- -------------------------------------------
NAME OF ADDITION --------- -E - �-- V�k
--y Jr.
DATE..... �-ZLg -------------------- By� 1�e-V-4 -------------------- ..........
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 liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS SIDE SEWER'PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 77 -2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ..... 2 ...... ................... _-...T�g .......... .. ............ -- -------------------------------------------
....... ��z . ........ I . ..... ! ............................................ . .............................................
PROPERTY LEGAL DESCRIPTION ......
n r- JR /�' 14,A::'I< i
...................... . ........................... ........... .. . .. . ... ........................................................................ . .......... ... . ........... ....................... ..................................................
....... OWNER AND/OR BUILDER_2� ... 4- AA Ed ............................................
I I . ----- -------- I ..... ........
-----------------------------------------------
%__.JrRACT0R'S NAME & ADDRESS ....................................................................................... . .............................. . ... .......................................................
Permission is granted J....— ... (_,� .............. . .. . ........... 1 19-?. for repair and/or connection of a side sewer to the city sanitary sewer
.... ... . ..
system in accordance with Citi—oflilmonds ordinances.
ATTENTION IS CAT-1 D TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No, 2—AII work performed in city right-of-way requires an Invasion of RJght-of-Way Permit obtainable from. the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work an the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED[:] Date ... . .... ........ ..................... By ................ Date -------- ------ By ---------------- Date .............. . ................... . By ----------
................. By ... ..................
APPROVED 9LDate...-.7 -- - -- - -- - ------------------------------- -------------------------------------
Remarks: ....... . ....... .......................... . ... .......................................................... . ...................................... . ...................................................................
............................................................. . ........................................................................................ . .................................. . .......................................................
Z BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
....................................................................................... ... I hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Construction)
was installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water [], Gas [], Telephone E], Power E], Sewer C], Other E] N1
The tity of Edmonds
0
OWNER ----
JOB ADDRE,
APPLICATION
for
SIDE SEWER PERMIT EASEMENT NO . ............. ------------------------------
NEW CONSTRUCTION REPAIRS Ej LID NO - ------------------ ASMT. NO.
-- --------- ------- ----- CONTRACTOR ------------- ---------------------------------------------------------------------- PERMIT NO;;.W. ..
0. 49�
LEGAL DWRIPTION: LOT,,N ... BLOCK NO - -------------------- * ---------------
........ /�r. . .. 4�7 --- .................................................................
NAMEOF ADDITION .......................................................................................................................
') � fl, W )
Approved:
DATE............................................ By ............................................................
11/75
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BUILDI-MG DEPARTMENT
Applicant Fill
USE
ZONE NUMBER
PERMIT APPLICATION
Inside Hea;y Line,
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ADDRESS
NAME JOR NAME F BUSINESS)
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LEGAL LOT
."kYES _1E1 NO
LJOT AREA
SUBDIVISION NO.
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MAILING ADDRESS
CITYL,> ELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP.PLAN G4 FT. Fr.
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NAME'
REMARKS
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LEPHONE NUMBER
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WIRING REQ'D. WYES NO
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TYPE CONNECTION VJ�YES
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SANITARY SEWER NO
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CITY
TELEPHONE NUMBER
SEPTIC SYSTEM PL&AMIT
APPV'O BY CITY ENG. YES
19NO
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NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBE
REMARKS
Legal Description of Property (Show Below or Attach Four Cc ies)
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METER SIZE
BUILD;NG SUPPLY SIZE
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REMARKS
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SIGN AREA
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ADB NO.
REMARKS
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FRONT 7A q-nv _R
ILOT COVE G
GAS
NEW R:SIDENTIAL LINE
FIRE ZONE
TYPE OF CONSZrRU ION CODE
ADD N N-RESIDENTIAL SIGN
RETAINING
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F ALTER EXCAVATE FENCE
OR FILL
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REPAIR PRE -MOVE swim
1:1 INSP. POOL
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1'77 3
SPECIAL INSPECTOR AREA
REQUIRED
YES
OCCUPANCY
GROUP,
OCCUPANT
LOAD
PL,�AN CHEC ED PY THIS SITE IS L iF CITY
_0 OF EDMONDS. LOCAL SALES TAX
_0 SHOULD BE CODED 31.04.
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NUMBER OF STORIES
7
NUMBER OF
DWELLING
UNITS
ORK TO BE DONE
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PLAN CHECK
NO.
VALUATION
FEE
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RETAINING WALL
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SWIMMING POOL
CITY OF -EDMONDS
EXECUTIVE DEPARTMENT
TO:
UTILITY BILLING
MAYOR
Uj
D
0
Uj
<
SUSPENSE DATE:
As We Discussed
lnvestigdte
and report
Take Appropriate
Action
Prepare Letter/Memo for:
My Signature
Mayor's Signature
Previously Ref'd
Status of Action? -
For Your Information X
Return to:
MAYOR'S ADMIN. ASS'T.
BUILDING OFFICIAL
CHIEF of POLICE
CITY CLERK
----------
CITY ENGINEER
------------
CITY PLANNER
FINANCE DIRECTOR
FIR , E CHIEF
PARKS & REC. DIRECTOR
PUBLIC WORKS DIRECTORI
COMMENTS:
COMMENTS
Permit #770647 was issued with the address of
LBuilding
23604-76th Place West.
0 t
The correct address is
23606 76th Place West.
i
(Muryl R. Med na)
I I r-l?()M- A. El I in
DATE: 11-7-77
.—j
(8/76)
'J. J (7 ',5- LIST
Y1 )l!:PT. WTT!,
AVE w
I Street rdjTht-oE-1-:,i,, Existin-
Access Easements F.Kistim TZ17 j)
g 'n K- A-
utilitv Fascliclit 11'xistinc, IZY..O!) Nk
Lot Per Siib�!iv,;sion PI at— Assessor "'zio
Sito Plan rl:cc!�('Cl for Accurac�
`7
!Zcon. ye's
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Existing 'Ili i n S i ::,a C_ z
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EXISTING STREET R/W 'g 4 -
FT. DEFICIENCY THIS PROPERTY
0
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ELEPHONVNUMBER
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COMP. PLAN ST. R/W 5— A,
FT.
7
REMARKS
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TELEPHONE NUMBER
SEPTIC SYSTEM 0 YES
PERMIT NUMBER
BY CITY ENG.
IRNO
z
0
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
I Pnal Dpqrrintinn of Prooertv (Show Below
or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
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0
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IL lo�
m ALLOWED PROPOSED COMPLETE EXEMPT
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J REMARKS
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YARDS LOT COVERAGE
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0
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0
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0 ALTER
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GAS
RESIDENTIAL LINE
NON-RESIDENTIAL SIGN
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PRE -MOVE swim
1:1 INSP. POOL
'� 5-/FRONT' / SIDE REAR
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TYPE OF CONSTRUCTION
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SPECIAL INSPECTOR
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AREA
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OCCUPANCY
GROUP
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OCCUPA
LOAD
I
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF, -WORK TO BEDONE
-OT PLAN (INDICATE EIUILDINCx 51=THA-_K5.
ABUTTING STREETS)
1061 e
4
PLAN CHECK
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PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION FEE
W
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CL
0
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W
W
Z
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