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432 OLYMPIC AVE
(Y 9 0 - 1 9 9 -
'STREET City of Edmonds.
RE=RN44#T&-6F-WAY CONSTRUCTION
PERMIT 0 Permit Number: 0
NOV 1 3 1991 IssueDate:
ENGINEERING
A. Address or Vicinity of Construction: _432 Olympic Avenue
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company Contact: Gary Swanson
MailingAddress: 815 Mercer Street, Phone: 224-2080
State License #: Seattle, WA 98111 Liability Insurance:. Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. '"n Commercial [—] Subdivision [I City Project R] Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family El SingleFamily n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut E Yes EIN4 �) G. Size of Cut: —2 x 4 - H.. Charge
@ Gas $Under asphalt sidewalk)
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harrnlessfrom injuries, damages, or
claims of any ikind or description whatsoever, foreseen or un/oreen, th-at ' ppfr-n e, City of Edmonds, or any of its departments or employ-
fefjrA�ns
-T' � ! th
n is, J 'tt fi �y reason ofgrantin
ees, including or not limited to the defense of any legal proceedings inchid n e, e cor a a oql ees
g this permit.
LS
7HE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A AD MAZA LYS FOR A PERIOD OF ONE YEAR FOLLO WING THE FINAL INSPEC77ON
AAD ACCEPTANCE OF THE WORK ES77MA TED RESTORA 77ON FEES-W111"BE HELD UN77L THE FINALSTREET PATCH IS�COMPLETED BY
I '�'t 11 1
CIYY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED -FOR ISSUA&E Td7HE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Eniihckring 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 timesfor in
Signature: Date: October 30, J991
(Contractor or.Ag6nt)'
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
M
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comffients:
Diagram:
(Fund I I I Route copy to Street I*pt.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
WashlngtLn
Natural s
AVAzhrgton D)ergy G-Parry
Addendum to :
Submitted by:
4-'52- Ou-�Wv-, iN�\,/
"OT //
Z d�/r--1211 XX
WNG to window
k*Water main depth
unknown
�- 11 gas main_
City of Edmonds
Right of Way
Permit Application
Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
page 5-69
(-ZX4) Co", C—O&S
\N&L-AL)
100
-w- water
-g- gas
-ss- sewer
water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
APPLICATION
for I
The City of Edmonds SIDE SEWER PERNMaT TMENI: PLANT'
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . ..........................................
. ...... PERMIT No.
ow;zER ....... ................................................ CONTRACTOR
LEGAL DESCRIPTION: LOT No. ............................ ........ BLOCK No . ................... .... . ... ............
hURESS .... ------ ..........
—J NAME OF ADDITION 2.4 9 W.0.0.d ....... Yl .. ........
.............
47
e-/
'16
P. ac �' :
SEP I a 1� �
Approved: C)AJ -Q::� 3
C4 t*( /,I L.,
DATEY:771-721"ff� .............. By ............... ......................