24226 78TH PL W.PDFlill 11111111
6799
24226 78TH PL W
CI-14� OF EDMONDS
COMMUNITY SERV,cSTPZETNf LE�scvvfr-D
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. * Owner: Washington Natural Gas CompawG
Ndff Mercer Street
N1
,4kytMdress WA 98111
City State Zip
Permit No. QC -7
Issue Date
Contractor:
Name
(fle
0 ,
Mailing Address
City State Zip
State License Number Telephone Number
C. * Address or Vicinity of Construction: 24226 78 Place West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: 0 Sub or Plat El Single Family El City Projects
0 Commercial El Multifamily Lt Utility
E. 0 Pavement Cut: 91 Y El N F. 0 Size of Cut: 2 x 4 (1) @ Water
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 kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
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 time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with 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: Aumnst 19, 1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: Rch( V\/ PERMIT FEE: 30 A& �H
Z Time Authorized: Void after AUGr 7_5 days. Restoration Fee:
0
"i Special Conditions: P� Eon RL 10 &, —rc) Receipt No.:
En
<L_,,jJLp_
y S 1CA L_ 7(::) Fund I I I Fee:
>� T�00 W C A-U 61 -&(04�N Street Cut Dimensions: x $
U RELEASED BY: Date!9-2)- -L�\ 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 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved BY:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
Washbgton AMMMMW-Mffi�
NWhAr5l Gat—M. �`-
AVAzhngtonB-WCMp&jV
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by:
ZZ(-p -76 A, -vV
J
Qk-
WNG to window
Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 995-6914
� (2A 'A' -) (F, -W&Te��
Water main depth Key:
-w- water
unknown -g- gas
-ss- sewer
n de
All gas main--,__- -e- water hydrant
0 water valve
5 Merccr St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
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 for - th 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
emp-l-o-yee-s or officers shall be Ha-b-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
OWNERO.W...' ..... .............. ...... 1—:.- ...........
'q
HOUSE No. ........... .............
10-
vu
APPROVED
Date Approved:
BACKFILL WORK ORDER ISSUED .... ................................... DEPOSIT, ......................................... ...........
SEWER WORK ORDER I SSUED ............... .................................. DATZ� ......