23619 74TH AVE W.PDFIIIIIIIIIIII
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23619 74TH AVE W
DATE RECEIVED
FPERMIT
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CITY OF EDMONDS
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NUMBER
CONSTRUCTION PERMIT APPLICATION
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OWMER NAME/NAME OF 8 SINESS
PLAT NAME/SUBDIVISION NO.
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LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
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Street Use Permit Req'd 0
Inspect on Required
SIdewa: � Required 0
Underground
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Regardless of whether the water system
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PLAN CHECK FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRX !Ng/FILL
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
j SEPARATE PERMISSION.
RCHARGE
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG IEW FEES
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
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IM ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4 RECEIPT.
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANYWAYTHE CITY'SABILITY TO ENFORCE ANYORDINANCE PROVISION.' A
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TOTAL AMOUNT DUE
192� L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF TH�LABOAFI CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S C J)NSURANCE AND RCW 18.27. CIALS SI ATURE DATE
FS IGNATUIIE (OW DAT�7; (425 lip KLA�
771 -0220
DATE
ATTENTION EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL7FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5/98
TREET
Qty of Edmonds
RIGHT-OF-WAY CONSTRUCTION. -
lip
FILE
PERMIT Permit Number: 94
al
Issue Date:
A.. Add I ress or Vicinity, of Construction; .23619 74. Avenue Wes t
B Type of Work (be specific): Install -New Service
C. Contracton. ..Washing toii Natuta . 1 Gas Company Contact *Gary Swanson NOV _U 3 Rn,f
Mailing Address: 815 Merder Street,. Phone: 224-2080 ENGINE
'Seattle, WA 9.8111 4HING
State License Liability Insurance: Bond: $
D. Building Permit (if applicable): Side Sewer. Permit #.(if applicable):
E. R Commercial El: Subdivision El City Project g Utility (PUD, GTE, WNG, CABLE, WATER)
R Multi -Family 'Single Family E] Other
INSPECTOR: INSPECTOR:.—
F. Pavement or Corcrete: Cut RjYe� 2) []No G.. Size of Cut: 2 x 4 H. Charge$
and Cross
APPLICANT TO READ AND SIGN,
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlessfrom injuries, damages, -or
claims of any. kind or description whatsoever, foreseen or unforeen, that may'be made against the City pf-Ednionds, or any of its departments or employ-
% I I � I . .
ees including or not limited to,the defense of any legal proceedings including defen�e costs, and allorneyfees by reason of granting this permit. -M
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MAMIALS FORA PERIOD OF ONE YEAR FOLLOWING THEFINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORATION FEESMILL BE HELD U�WL THE FINAL S7REET PATCH IS COMPLEYED BY
CITY FORCES, AT WHICH 77ME A I DEBIT OR CREDIT WILLBE PROCESSED FOR ISSUANCE TO I 7HE A PPLICA NT
Construction drawing of proposed work required with-permift application.
A 24,hour notice is required for inspection; Please call the Engineering Dep4rtrpentm 771-3202.
Work is to* be inspected during progress and at coinpleti
Restoration is to he 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 thepe�mit 'requirements and the pink copy of the permit will be available
on site at all limesfor insp
Signature: Date: October 28, 1991
(Contractor or Agent),
CALL DIAL -A -DIG PRIOR- TO BE61NNING WORK
FOR CITY USE ONLY
TIME T
AU HORIZEMY.0 DAYS� ::DISI
.SP . ECIAL..CONDMONS:. �Ird &A!5
PER
DATE: ..ISSUED BY:�A,(Ma=g��
. I...... NOWORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE. .-.
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund III - 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:
Date:
Eng. Div. July 1985
Washlngton��
Natural Gas—
AWWV)gton Er-W COMParly
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
-74 t�� \�\J 622-6767 x2761
pager 995-:-6914
WNG to
Water :
unknow,
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r—A -C,- 5�-
-w- water
-g- gas
-ss- sewer
water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
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