420 6TH AVE N.PDFIIIIIIIIIIII
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420 6TH AVE N
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117 C. JSoQ
C. Contractor:
City of Edmonds
RIGHT-O&WAY CONSTRUCTION
PERMIT Permit Numbe,.,?f- 7
Issue Date: A/—// �f&
A. Address or Vicinity of Construction: ca A0
B. Type of Work (be specific): !g i2:Z 12
q 50.7!;-
MailingAddress:
State License #:
D. Building Permit# (if applicable):
Contact:
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F1 Commercial 0 Subdivision El CityProject [-] Utility (PUD, GTE, WNG, CABLE, WATER)
0 Multi-Family(p SingleFamily n Other
INSPECTOR: "/7r—a;7- INSPECTOR:
F. Pavement or Concrete Cut Yes 0No G. Size of Cut: x H. Chargq_$
9
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold the City ofEdmonds harmlessftom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, 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 and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TIONAND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above
available on site at all
Signature:
and understand the permit requirements and the pink copy of the permit will be
spyctiop-purposes.
Date: /9
or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng, Div 1997
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
A
CITY OF EDMONDS SIDE SEWER PERMIT
18 90
c� PERMIT
Address of Construction:
Property Legal Description (Include all easements):
I ve, r"
f 4 m-r,
Owner and/or Contractor:
StateLicenseNo. Building Permit No.
Single Family
Multi -Family (No. of Units—)
11 Commercial
11 Public
EDMO"
Invasion into City Right -of -Way: 0 No x Yes
RW Construction Permit No. 1��- -,_zi?-S,
Cross other Private Property: No El Yes
Attach legal description and copy of recorded easement
I certify"ibatfhave read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL-744-&M, PUBLIC WORKS DEPT.
Permit Fee: — 6eo Issued By
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
Partial Inspection: Date —Initial
Comments
Reason Rejected: Date —Initial
Final Inspection Approved: Date*4,F___InitiaI +(,
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3 90
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO . ..................
I
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR .................................................................................... PERMIT NO. .39-64..
LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
JOB ADDRESS q_�RQ ........ (07 ... AVI ......... &i ---------------------
NAMEOP ADDITION .......................................................................................................................
I)fl\ +�, A LIP,
EDMONDS
TREA0,jiEN'r P1 ANT
44 Pvc- i,)YF-
Cto I'dtxp.
co
N +o 4" PVC Fcrl%co
wi+k Lt" zz* BcAd
4" Cov\c WqF-
+0 q,, PIC-
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fv\ 114
QjWW-0001-1 1175 (REV.1 1/78)
AV F- N
Approved:
DATE................ ....... 4 . . .............................
WORK ON SHOULD�R OR PARKING LANE
W20-1
W20-1
<
< > FA A >
6 H AVE N
W,-SHOULDER OR
PARKING LANE
A
W20-1
VIVO,
0
0
0
SPEED
LIMIT
SIGN
SPACING
AB (FT)
SHOULDER
TpER (FT)
(10 SHOULDER)
BUFFER
(FT)
25
200
35
55
30
200
50
85
35
350
70
120
40
350
90
170
45
500
150
220
50
500
170
2 0
55
500
185
335
<�W21-5
*W20-1
I SNOHOMISH COUNTY
[PFLnF-D--1 TRAFFIC CONTROL PLAN
k RMIC MITY DISTRICT NO 1
PROJECT RELOC EXIST CAP* 4815 FOR FIVE CORNERS QVR APPLICATION FOR PUD
LOCATION 6TH AVE N. & DALEY ST. EDMONDS
ENGINEER HOON HA DATE 11/27/02 WO No 330426-Y 6
PHONE 425-514-5019
PAGER/
CELLULAR 425-347-9722/879-4547
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-7
City of Edmonds nrc i ruit No:
RIGHT-OF�WAY CONSTRUCTION PERMIT IssueDate:
A. Address or Vicinity of Construction: C)
B. Type of Work (be specific): f e k,,) �j -r e It :y i N A. <. C e, 1 CA C r age 4.:�
C. Contractor: T�
'�'u �140111 k 5 �N Contact:
MailingAddress: Po %UIC-1 07 Phone: ',-I z
State License Liability Insurance: _Kona' $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F-1 Commercial ivision F1 City Project Rr EUQ GPTI), VERIZON, PSE, AT& T, OVWD)
F-1 Multi -Family E] Single Family r-1 Other
INSPECTOR:
F. PAVEMENT CUT: n, YES 91 NO G. SIZE OF CUT x
CONCRETE CUT: [I YES [2_NO
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds 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 of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLL007NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT W1LL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
Agent)
Date: / z Z2 0 Z_
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00AOF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERHITTED WORK: DATE: 1612ylo 7
k(spector's Signature
. . . ...... For_inspection requirements see Engineering Inspection Information handout.
No WORK S11AIA, BFGIN 14MAZT0 IFRINIFFISSUANC11'
D:\MyDocuments\Forms\Engnmg\ROWpermit Am
PUBLIC UTILITY DISTRICT NOA OF SNOHOMISH COUNTY
LOCATION 420 6TH AV N, EDMONDS 98026 SOUTH CNTY AREA
POLE NO. SW 1/4S 24 T 27 R 03 . DATE 11/25/02 W.O. No. 330426
REASON FOR WORK RELOC EXIST CAP* 4815 FOR -ENGINEER HA TASK
EIVE CORNERS CVR APPI ICATION DRAFTER HA U.G. NO.
SCALE 1" = 100'
DATE WORK COMPLETED APPROVED DATE PRINTED
FOREMAN
FEES REQ'D 0 YES N NO
\PRIMARY OVERHEAD
RESIDENTIAL
C C(
OMMERCIAL
L
L NO.
SE NDARY OVERHEAD
BASIC FEE S
METERkCONV.POLE
PRIMAR� UNDERGROU
0 RESIDENNAL
0 COMMERCfOL
BASIC F E S_
LEU NO.
SECONDARY ND GROUND
A I s
S FEEE
UNDERGROUND AT
S FEE 3
q- FTAA - =$
STREET LIGVTING X .
q FTAS x =s
WORK IN �IGHT OF
0 PRIMARY
���Y
Y
FTAS_
MISCEL ANEOUS FEES
VAULT
PERMIT
s
TOTAL DUE S
7 TE PAID
ECEIPT NO.
W
NE SVCE APPLICATION NO.
LEGEND:
ENVIRONMENTAL ANALYSIS
0 EXEMPT 0 NOT EXEMPT
PARA. 18 ITEM C�
O.H. U.G. COND. KV
ADD CKT. FT. PH
REM CKT.FT. PH
NET CKT.FT.
. G. COND.
ADD CKT
<.PH
REM CK * PH
>
N CKT.FT.
PERMITS (DATE GRANTED)
• TREE TRIM
• STATE
• COUNTY
• EDMONDS
0
�ASEMENTS
0 REQUIRED 0 NOT REQUIRED
DATE RELEASED
NsOREIGN CONTRACTS
IZON JPN NO.
0 " JPN No.
C7AT JPN NO.
• JOINT TR VERI & CATV
• JOINT BORE V ON & CATV
0
0c
POLEXENCILINGNI,,
FROPOr TO —
AOFF POLE
PRE—CONST. REQUIRMENTS
0 TREE TRIM 0 PUD LOCATOR
0 BACKHOE E FLAGGING
0 ONE CALL DATE
No.
READY
PHASING
GIS
WORKING POLE/
XFMR
DMS
FINISHED
1 LINE
JOINT USE
LOCATION MAP PAGE 454,F5
0 EXISTING POLE
19 EXISTING POLE -TO BE REMOVED
0 NEW POLE
)K NEW POLE TO REPLACE EXISTING POLE
SUBSTATION FIVE CORNERS
CIRCUIT NO. 12-1283 PHASE 123
ENGR'S TEL. *
F425-783-50191
ENGR'S PAGER #
F425-347-97221
N
HANG
CAP#4815>\
(9
D A LA
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co
17-17102
slecy)
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------------ ---
4815
1
COMP*3-9
RMV 450KVAR CAP BANK:
DIST* 4815
123
3
CAP#4815
BEFORE
123
CAP*4815
3-10
1 1 3
U a 9:4
SCHEMATIC
NTS
COMP*3-10
RMV 7'XARM ON EXIST POLE.
FRAME 30 FIXED CAP BANK MOUNTING (12F615) ON EXIST POLE.
HANG 450KVAR (DBO109) CAP BANK & FUSE AT 25A:
DIST* 4815
TRF EXIST (3) 3/0 AL PRI & 3/0 AL NEUT.
TRF EXIST *6 CU PRI & NEUT.