24315 76TH AVE W.PDF111111111111
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24315 76TH AVE W
1 8 9 0 - 1 9 C� -
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RIGHT-OF-WAY CONSTRUCTION
PERMFF Permit Number,
STREET FILE Lssue Date: -- 15-941
. A. Address or Vicinity of Construction: - 24315 76 Av W (9414037) —
B. Type of Work (be specific): Install New Service
C. Contractor: -Washington Natural Q s 6mpany Contact: Frank Swab
Mailing Address: 815 Mercer St. Seattle WA Phone: 224-2278.
98111
State License #: Liability Insurance:._ Bond: $
D'. Building Permit # (if applicable): Side Sewer Permit # (if applicable)-
E. E] Commercial E] Subdivision n City Project [A Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family [:] Single Family F] Other
INSPECTOR: INSPECTOR:
F. PaVement or Concrete Cut: 0 Yes 6dNo G. Size of Cut: x H. Chargq_$
APPLICANT TO READ AND SIG'&
un, agrees to h
.�hj tyofEdmon,,d haA.� 'J damages, or
INDEMNITY. Applicant understands and by his signature to this applicati, Ci C-1
t fly of 8 . ' gepartments or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be miiddod�/ he C' d On F. f—
employees, including or not limited to the defense of any legalproceedings including deft ah2attorney fees by re on 4-antidgiihispermit.
0
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 FJES-W��B�HELD UNTIL THFFIN14P. TC
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED ORISSUANCETOTHEAPPJ NT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required f6r inspection; Please call the Engineering Division, 771-0220.
Work and material is to be insp�cted 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 �ppy oved material prior to the end of the working day;
NO EXCEPTIONS..
Ihave read the %bovestatements and understand thepermit requirements and thepink copyof thepermit willbe
available on site at qgA�"rps7br inspec i . on purposes.
Signature: 6W Date: April 4. 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:1 RIGHT OF,WAY DEPOSIT,
v
TIM E A UTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 11.1:
SPECIAL CONDITIONS: RESTORATION FEE:
COMMENTS:
DATE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL. BEGIN PRIOR TO PERMIT ISSUANCE EngTg. Div. 1991
Jf I, -
FIELD INSPECTION NOTES
I Comments:
I Diagram -:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
AV*OrQcn&VWC*nWV
Addendum to City of Edmonds
Right of Way
Permit Applicaiion
Submitted by: MITCHELL S.-LANKFORD
Engineering Aide
Washington Natural Gas
# ."521 �5246
f7w. c- -�j '::�q
WNG to Window
W
A±-er_ rnain depth
gas main
MW
Key:
-w
water
-g-
gas
-ss-
sewer
--e-
water hydrant
0
water
Valve
. . -.2 ,
3!'� h;'-ccr St- ��)- F"'X -�"' , Sca'tk. 'VA "I I I � �2r,)6) 622.--;67
CITY OF EDMONDS
PUBLIC WORKS DEPARTMEN,�%,
RIGHT - 0 . F - WAY CONSTRUtTWPT FILE
A. eAddress or vicinity''of Construction
'24315 -76th West
e Owner: ('h. a- r- 1 e sz u- r- n, r.
Name
94115% 76th Wesi-
Miilin Address"'.
9
Fdmanrl-, WA�-,h ()RQ20
Cit S t a t e, '..Zip Code
Permit No. JCI(o 4-/
Issue Date Zz � 110-76
A I .
o Permit Issued TO:
Olds E)'Ly1LL&.LC
e � Type of Work to be Done: aspha I t paying
in Connection With:
0 Sub or Plat -.0 Single Family
0 Comml. / Ind'. .0 Apt. Condo.
Pavement Cut: 0 Yes 0 No
Contractor:. 01=pic- Tnr-
iso
7 BO
27
M rise
Mailing Address �tatc ice Ifu&m b c
Lynnwood , Wash A 0 -16
z �irer
City, State, Zip'Code TeleMo& 10
U
:1 . *.* NO WORK TO BEGIN. PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
co INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
14 from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that rhay be made
against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal
0. proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
0
U Upon issuance of this permit, the contractor is responsible for workmanship.and materials for a period of one year
following the final inspection and acceptance. of the restoration by the Engineering Division.
0
Funds held from the Security Deposit'(estimated restoration fee) will be held until the.final street patch is completed, at
which time a debit or cr�dit will be processed for issuance to the applicant..
Wor� is 'to be inspected. Restoration to be in accordance with City Code. Tr�ffic Control to be in accordanc'e with Traffic
Section of City Code. Street'to be kept clean at all times. A 24. - hour notice is required for inspection by Engineering.
Call 775-2525, extension -2%*- OL 517,
I understand that this permit: must be ai e at b site inspection purposes at all times.
fp; * .. r- —i�/-
Signature:
Owner or
THIS PERMIT MUST BE PSTED AT THE - JOB (
DIAL - DIG PRIOR TO, BI
Date A- J
FE'FOR'INSPE&ION PURPOSES
INNING WORK
Permit Fee:
C. Issued Ely:
urity'Deposit:'
Time Authoii-z'ed: .,Void"after 4�a �"Sec
ns k*�ceipt No.
z
Special Conclitio
:S! "J,
F Fun 11 Fee:
d
un
Ammendments: oz/,?X� ',Street Cut Dim'ensions
X
7-0 2FE42-
0 45 1,oV
A/mrie- ?v A," e Arl7ff '4®rwl z1r H69"
0 WORK TO BEGIN PRIOR 10 PERMIT JSSUANCE
V— n;- n--�— 1 G752