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520 SEAMONT LN
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TAX ACCOUNT/PARCEL NUMBER:,,;-' 70.,
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION. E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
PERNM
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID#:
SHORT PLAT FILE: LOT: BLOCK --
SIDE �SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOELS REPORT DATED:
STREET USE ENCROACHMIENT PERMIT
FOR..
WATER M[ETER TAP CARD DATED:
OTHER.
LATEMPOSTAFormASavd File Checklistdoc
APPLICATION
for
The City of Edmonds SIDE SEWER PERMT
NEW CONSTRUCTION REPAIRS 0 EASEMENT, No . ..........................................
104-04400
Jesse ... D.--- Lon .........
OVfNER ......................... .... ......... g ................................................................ CONTRACTOR ........................................................................................ PERMIT No . ......................
ADDRESS -------- 5ZO ... Saamout ... L-an.e ........................................................
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LEGAL DESCRIPTION: LOT No . ....................................... ...... BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
DYE TESTED Oil SEWER
JULY, 1972
Approved:
DATE................................................ By ..................... ................................................
City of Edino&
RIGHT-OF-WAY CONSTRUCTION
Issue Date:
PERMIT
Permit Number.
A. Address or Vicinity of Construction: 520 Seamout
B. Type of Work (be specific): EmerggAcy LeA
9 0 9 C) �r
C. Contractor: Washiggitou Natural Gas Contact: Jauis Woods
Mailing Address: 1122 75 St SW Everett Phone: 356-7515
98203
State License #: - Liability Insuran - Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [-) Commercial E] Subdivision El City Project FX] Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family Single Family E] Other
INSPECTOR: I14SPECTOR:
F. Pavement or Concrete Cut: 34Yes []NO G. SizeofCut: -Itlx H. Clprp�_$
APPLICANT TO READ AN] IGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg 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 or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
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 FORe—kS, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for insp purposes.
Signature: M 8-27-96
t
2� Date:
ra4r-o�-rW�—ny
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CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVE I D BY: goy
5e
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: PAVI N(q 11-� 13
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
COMMENTS: -RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMITISSUANCE
Eng. Div. 1994
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RIGHT-OF-WAY CONSTRUCTION
PERMIT PermitNumber- �, Lai /
Issue Date: -3/-9(/
A. Address or Vicinity of Construction: 5.20 Seamont Ln. (9408257)
B. Type of Work (be specific): Install New Service
Contractor: Washingaon Natural G a CoizimqU Contact: Frank Swan
Mailing Address: 825 Mercer Wt. Seattle, WA Phone: 224-2278
State License #: Liability Insurance: — Bond:$
D. Building Permit X(if applicable):
Side Sewer Permit,# (if applicable):
El Commercial El Subdivision 0 City Project [ik Utility (PUD, GTE, WN6, CABLE, WATER)
n Multi -Family EJ Single Family F1, Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 6d Yes iCl No G. Size of Cut: 1 (2 x 4) H. Chargq�_$
I . Cut in pay0g) -at Rebvice Tie-in
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to Misapplication, agrees to h "'he City ofEdnioii6 �cirml� 4Mmages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be.made a ainst the City of Edmonds, or any bf its dej�rtments or
I -
employees, including or not limited to the defense of any legal proceedings including def6rise,costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP:AND MATERIALS FOR'A- PERIOD OF ONE YEARI 176LLOW�NQ THE FINAL
I - .-
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION,�kES�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 TUT&T��PJ14�CANT.
Construction drawing of proposed work required' with permit application.
-A 24 H6-xii�hotice is required for inspection; Please call the Engineering Division, 771-0220.
� 91
Work.,and matdrial is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street sh�ll be'kept glean at all times. 1.4
T�affic Control and Nblic 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 app'rbVed material prior to the end/bfthe'w'�orkin"g day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit willbe
available on site at all�t �*or inspection purposes.
.00-0 /
Signature: 01,&-gmw - Date: January 20, 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME ALTTHORIZED:�VOID AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
TOTAL FEE:
RECEIPT FE]
k
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1991
.16;=M
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Y Addendum to Citx of Edmonds
Right of Way
Permit Applicaiion
-;ubmitted by: PtI�TCHELL S.-LANKFORD
7-0 Engineering Aide
Washington Natural Gas
# -521--:5246
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815 M=cr St. (P.O. Box 1869), Scank, WA 98111 (206) 622-6767