23904 78TH AVE W.PDFlill 11111111
6711
23904 78TH AVE W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: 1?0z —
RTPIFET FILE Issue Date:
A. Address or Vicinity of Construction: 23904 and 23906 78 Avenue West
B. Type of Work (be specific): Install 1 1/4" PE IP Main in 78 Avenue West
9 0 - 1 9 at 328' North ceuterline of 240 Street Southwest. Per Attached
DrIw6ppC0920-367 (IR 6043-3)
C. Contractor: -Washington - Na tura a mpany Contact: (1) Frank Swan
MailingAddress: 815 Mercer Street, Phone: 224-2278
State License #: feattle, WA 98111 Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [_� Commercial F] Subdivision F1 City Project Pg Utility (PUD, GTE, W`NG, CABLE, WATER)
F1 Multi -Family [I SingleFamily F1 Other
INSPECTOR: INSPECTOR: Rol
F. Pavement or Concrete Cut : 191 Yes []No ( 1 ) G. Size of Cut: 2 x 4 H. Charge$
APPLICANT TO READ AND SiGN
INDEMNITY. Applicant understands and by his signature to this application, agreesktShald-Je City of Edmonds harmlesspolh 4104se �a4ges, 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 CON7RACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA7ERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL S7REET PATCH IS COMPLETED BY
CITY 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 Department- 771-3202.
Work 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.
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 times for inypect * 1 1
Signature: Date: January 31, 1§92
(Contractor or Agent)
CALL DIAL A -DIG PRIOR TO BEGP4NING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER APhit, 18 DAYS DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: MAo41-AN 6 FeET RESTORATION FEE:
SEP FINat-A C-IT%( PERMIT FEE:
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
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3ILL OF MATERIAL
PERMITS: f�,DAAoKlC>S 1 1 !4 SEC. 'Se --?,I
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W. -JESCRIPT;CN DATE I BY, APP-0
DRAWING
REVISIONS
SCALE.
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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
The City of Edmonds for EASEMENT NO . .............................................
SIDE SEWER PERMIT
]EW CONSTRUCTION REPAIRS E] LID NO. NO.
OWNER . . ....... LAF=) ----------- CONTRAt;TOR
.......................................................... PERMIT NO.
JOB ADDRESS LEGAL DESCRIPTION: LOT NO .. ....... ---------------------- BLOCK NO - ------------------------------
- ------------------------------------------------------------------------------
0
0
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a
.............................................................................................................................................
NAME OF ADDITION ------- I ........ -r I
.............................................................................
L-cDlr.L
-411 -
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Approved:
DATE ... L, ...... .....
The City of Edmonds
APPLICATION
for
SIDIE SIEWER PERM
NEW CONSTRUCTION El REPAIRS E]
EASEMENT NO.
LID NO. .1-'.6 ------ - ASMT. NO - ------------------
OWNER ----------------------------- CONTRAcToR,Am-sT
JOB ADDRESS .4234747-f ---- ------- �4? A�c W LEGAL DESCRIPTION: LOT NO. ------------------- PERMIT NO.
------------------ BLOCK NO - -------------------------
.............................................................................................. ---------
NAME OF ADDITION -4-2-As ......
I
I
30 26 1976
pow VwV& DIV.
Approved:
DATE----------- -------- * --- I ------ I ---- -, ----- By ---
67. / GY 9-
61J10-i
nuirmcp
0 1 Eju" - FILEE D N1 0 N D S
- SEffiR DEPARIMENT -
RECEIVElY
'JUN' 7 m4
PUBLIC WORKS
STOPPAGE OF SANITARY SEIVER MAIN RE -PORT
I
DATE: TINT- CALL RECEIVED:
LOCATION' -OF STOPPAGE:
TINE OF ARRIVAL ON THE'JOB SITE: -Z"- cy)
TINE NORNIAL FLOW OF SANITARY SEIVER REESTABLISHED:
CAUSE OF STOPPAGE: kq me" "A I -tr, vk�� s- e ',:% Le,
1�j I
U424 OC�
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL:
'114 1),2, - i �6 6 C. 4�.
CITY CREIV ON STOPPAGE CALL OUr (Personnel Involved): *-2 . f .. -
LOCATION OF RESIDENCE AFFECTED:
MME, ADDRESS, AND PHONE NUMBER OF PROPERTY OhNIER: oko "Sse-S
,�qo 7 Ad�p 14je
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DESCRIBE DAMAGE
TO
PRIVA11-
PROPERTY:
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