520 4TH AVE S.PDFlill 11111111
5080
520 4TH AVE S
APPLICATION
for
The City of Edmon,ds SlID19 SEWER PMMT
EASEMENT No . ..........................................
NEW CONSTRUCTION El REPAIRS 0
l0e) -
CONTRACTOR-_.. ..... ............................................ .......................... ......... PERMIT No . ...........
OWNER ---- .......... ....................... ..............
. ..................................... ........... LEGAL DESCRIPTION: LOT No . ..............................................
ADDRESS ..SaO ... 7 ......... AVC BLOCK No . ...................... .....................
NAMEOF ADDITION ................................................................................................................
.......................
U.
LU
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ct)
/q 7cl
Diva, Tas4ed on SaWar
Approved:
DATE....................................... ........ By .......................................... ...........................
City of Edmonds Permit No:
. I
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: A
A. Address or Vicinity, of Construction:
lu S ixl�: lal-0
B. Type of Work (be specific): A 2-� PW�Slgxr_ VIMII mi_�yw (W 'e,
JA.Iaq 01%12c!)�� 3, S
10, U C/',� �uw L xv Slum,
,�Atl 0A AIM
C. Contractor: ri� (4 LSLiZD 11�&�
122 75th S-.2 a;]
Mailing Address: I —
State License
D. Building Permit # (if applicable): 4
Contact: f,'OUG USfTAL0
Phone: (425) 356-7520
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):'.
E. Commercial E]' Subdivision City, Project-f]-- EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family n,�Qther,
INSPECTOR
F. PAVEMENT: M YES F1 NO G. SIZE OF CUT 4 x 2 H.Charge: $
CONCRETE CUT: N YES NO,
APPLICANTTO READ AND SIGN
IDEMNITY. Applicant understands by hislher I signature to this application helshe holds the City ofEdmonds harmlessfrom 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 MATERMLS 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 TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT,
* Traffic control and public safety shall be in accordance with City regulations as required by the, City Engineer. Ev ery
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.
4 Three sets of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THATIMUSTMAKE THE PINK COPY OF THE PERMITAVAILABLE ON., ' I A Ti ALL TIMES FOR INSPECTIONS
Signature:
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-4214-5555) PRIOR TO BEGINNING WORK.
FOR CITY USE ONLY 00
Approved by<�PU, no I �_ Right-of-way Fee: :J6
Time Authorize : Void After /00 Disruption Fee/Fund 111:
Special Conditions: Restoration Fee:
M 91W Total Fee:
cGaA& Receipt N ' 6'
Issued by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMO
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK,
INSPEE )!TOR'S SIGNATURE DATE: 61.4)
For inspection requirements see'Engineering Information Handout..
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
------ 7 ----------------------- NOTES --------------------------------
1. CALL 2 DAYS BEFORE YOU DIG 1-800-424-5555
N
11'�501
VALVE
11'W'19's
C�
CY)
- (L' 1"V]
60'
co
'd..
C4
W HOWELL ST.
7'
EX. 2" PE LO LO
IP 16�S C\2
91 -485 EX. 2" PE IP 16' S
'970�9033
�0'
VA VE
\f7'W, IL6Y'SI
a. C4
> co
co
2" PE IP MAIN 18' W
I TIE-IN 0 209'S,18'W rL L
6 0'
END MAIN 250'S, 18'W rL
2. CITY OF EDMONDS:
Maintain a minimum of Whorizontal
and 3'vertical clearance from all
city utilities and appurtenances.
Cuts in paving are shown as 0
e cuts in paving anticipated.
Notify Engineering Division 24 hrs
prior to construction - 425-771-0220
3. PROJECT MANAGER: DOUG USITALO - 425-356-7520
GAS MAIN INSTALLATIONRETIREMENT
IR
SIZE
LENGTH
TYPE
MANUFACTURER
1
211
40'
MPE
1
11, 4 "
MPE
PRELIMINARY ONLY CALL 1-800-424-5555
Not for Const-rucqqp s,,-,c, 2 BUSINESS DAYS BEFORE YOU DIG
NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
5
REAL ESTATE/EASEMENT
PERMIT
EDMONDS
4
3
FUNCTION
NAME
PHONE NO
DATE
2
PROJECT MGR:
D. USITALO
(425) 356 -7520
12/ 21V 99
1
ENGINEER:
/ /
REV#
DATE
BY
DESCRIPTION
DRAWN BY:
C.S.
12/21/99
COUNTY
EMER SEC
Work Center
CHECKED BY:
/ /
APPROVED BY:
(425) 356 -7520
12/21/ 99
1/4 SEC
NE- 26-
27- 03
OP MAP
164.62
PLAT MAP
164.65
U-MAP# (POWER)
CIR MAP#
CIRCUIT#
IMAPPING:
JOINT FACILITIES
ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
PUGET
SOUND
ENERGY
2" PE IP MAIN EXTENSION TO
SERVE: 520 4 AVE. S.
EDMONDS, WA.
INCIDENT#
DRAWING#
107008284
SAP SUPERIOR ORDER#
107006284
SCALE:
1" 50'