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531 SEAMONT LN
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ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR -
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver Ej Study Required [] Waiver
DISCRETIONARY PERMIT,,#'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
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) M
SOILS REPORT DATED -
STREET USE ENCROACHMENT PERMIT #:
FOR:.
WATER METER TAP CARD DATED:
OTHER:
LATEMAbSTs\Fbnns\Sftret File Checklistdoc
V 4
Cit 'of EdAL 0
RIGHT-OF-WAY CONSTRUCTION
PERMIT -r -3 3(0
Permit Number. '4 a.
Issue Date:
A. Address or Vicinity of Construction: - 531 Seamont Lane
Q B. Type of work (be specific): Rep lace existing pol.e to get ready for -
71,81910 W19
Belt Shout Plat Construct approx 2/1/97
C. Contractor: Spohomish COunty PUD 'NO. 1 Contact: Aerry Elkington/Gary McLaury.
MailingAddress: pn gnm 1107 Phone: 347-4434.434-5698
State License #: Liability Insurance: Bond:$—
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdivision E) City Project )M Utility (PUD GTE, WNG, CABLE, WATER)
Multi -Family: El Single Family Other
INSPECTOR: 114SPECTOR: kw
F. Pavement or Concrete Cut 0 Yes )BNo G. Size of Cut: H,("Charg. -
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APPLICANT TO READ AND SIGN
N�
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 incluii4!1;fe,7a1FMt., and attorney fe..ky��-.AW9'f
'grq,;�qgthispermit.
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 FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPL ICANT.
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 com pletion.
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 o e at all times liorin pectio urposes.
Signat Date:00popbPr 13, 1996
lwontractoL�Aentf
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
4;.
NO WORK SHALL BEGIN PRIOR TO PERMIT.,kSSUANCE Eng. Div. 1994
00
FIELD INSPECTION NOTES
Comments:
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:
CREW TO HANDLE OUTAGE AREA
FP> 11D 0),
Faxwommialml PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY SBSEED.DGN
LOCATION 531 SEAMONT LN, EDMONDS 98020 SOUTH COUNTY
POLE NO. N W 74 2 5 (2 7 - 3)DATE 12-11-96 W.O. NO. 23
REASON FOR WORK ENGINEER GARY MCLAURY DWG. NO. 118296
REPLACE DEPRECIATED POLE FOR FUTURE DRAFTER GM U.C. NO.
�.,"USE AS A RISER TO SERVE BELT SHORT PLAT SCALE 1*=100'
DATE WORK COMPLETED DATE PRINTED
APPROVED
FORMAN ENVIRONMENTAL ANALYSIS
FEES REO'D 0 YES 0 NO Z EXEMPT 0 NOT EXEMPT SUBSTATION FIVE CORNERS
P AR A. 18 ITEM C CIRCUIT NO. 12-1283 PHASE 2
PRIMARY OVERHEAD O.H. U.G. COND.
• RESIDENTIAL ADD CKT. FT. PH
• COMMERCIAL REM CK2T.F . JP H I UO
CLO E5T 5WITChs
LEO NO. NET CK FT. 12-1516
1 1 .. I
O.H. U.C. CO KV
�>e
ADD CKT. FT. PH
SECONDARY OVERHEAD
BASIC FEE S
REM,--," CKT. FT. PH
'@s =s I
lozf CKT. FT.
METER/CONV. POLE
PERMITS (DATE GRANTED)
PRIMARY UNDERGROUN
0 TREE TRIM
• RESIDENTIAL
0 STATE
• COMMERCIAL
/FE
0 COUNTY
EB13ASIC 19
N CITY FnmnNns--
LEU NO.
0—
@ S
EASEMENTS
SECONDARY UNDE�GROUND
0 REQUIRED 0 NOT REQUIRED
BAS FEE S—
UNDERGROUND T
DATE RELEASED
FOREIGN CONTRACTS
CA
EE S
ASIC FE�
q- FT =s
0 GTNW JPN NO.
STREET LIG NG
0 CATV JPN NO.
0 JOINT TRENCH GTNW & CATV
0 JOINT BORE GTNW & CATV
WORK IN GHT OF WAY
0 PRIMARY
0
r-1
POI E' STENCILING
FT.0 =s FROM TO
MISCEL ANEOUS FEES TAKE OFF POLE
VAULT S PRE-CONST. REQUIRMENTS
PERMIT 3 0 TREE TRIM 0 PUD LOCATOR
s 0 BACKHOE 0 FLAGGING
0 ONE CALL DATE
NO.
TOTAL DUE S 7 INDEX POLES I IPLAT
TE PAID LOGS U-MAP
ECEPT NO. XFMR C-MAP
EW SVCE APPLICATION NO. LOCATION MAP PAGE454 F6
ENGR'S TEL. #
F3F4�5C,28
ENGR'S PAGER
H 2qo-0208�
FILE::c:\dato\dgn\pdt96\p-bo\belt_41.dgn
DATE 12-Dec-9 09:56
2-27 (531 SEAMONT)
SET 45' POLE (6FT DEEP)
W/GRND.l'EAST
INST. 12V101
INST.12V601
REHANG 25 KVA XFMR
7200/12470Y- 120/240V
DIST# N-28543-X
SER#
TRANSFER (1) SERVICE
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Camstrimlicin damiziff of jimposed vwk ui"d W" pmu apownum
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Work and =WW jo to be ftepefted.durink pmgm mW at amipletion,
Baboration is to bein soommiance with City Codes.'
Stimet WsAU be kW1 clean at all Umes,
Tmft Control and?ubUe Safety" bem, "id" with aty repladow am required by the City rmgi&&.
Allstmteutftb obaR Watched with anAW& or CiWipmoved mahAml prior to the end ofthe working
NO EXCE MKS,
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At — 0
!4�ml�iiffmii P7 f Wp"4 twu k
lWm[Azb& t ma Aimw vm&,ppqrpm41L
13, 1995
NO WORK SHA Lf BEGIN PRIOR TO PERNTr SSSUANCE
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