639 ELM ST.PDF11185
639 ELM ST
4-
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
E6
PERMIT
Permit Number. "? 10
Issue Date:_/0 - 19 - 19 41
A. Address or Vicinity of Construction: .639 Elm Street
GTE to place,operate, and maintain a burleEr—service
C) D. JLyp-_01 Vy0xJLk0uSpeC111C): wire Trom existing pole 04134 located at 639 Elm at.
8 9 0- 19 to a residence at 639 Elm Street. GTE to ploa 30 feet pushing no drivewao
no ro?gsCo.1a?.1_ 5 feet- Blease see attached sketch
Mary A. Bower , Perm r nator
Contractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 mobile 388-1358
zs1z-C W. Casino Rd
Mailing Address: FverAi-t. Wa 99204-1440 Phone: Mary 206/4RR-192R nr 71n-4130
State License #: Liability Insurance: � Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [] Commercial El Subdivision 0 City Project EN Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family [] Single Family Other 2100-9P001DB 242310
INSPECTOR: INSPECTOR: VJt%"A'*A
F. Pavement or Concrete Cut: Yes G. Size of Cut: le H. Charg�_$
Please see attache sk ch.
AP;V6AANT TO READ ANDk /0-7.,
INDEMNITY. Applican t 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 FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing 4proposed 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.
I have read the above statements #"-maders tand the permit requirements and thepink copy of thepermit will be
available on site at r ses.
za M�M�
Signature: John H. Stewart Date: October 3. 1996
(Contractor or Agent) Oprns Supv-0SP Engrg
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY, USE ONLY
APPROVED BY:
RIGHT OF WAY DEPOSIT,
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS:, No AO Cv r RESTORATION.FEE:
e-ID'A 0 IV A Y PERMITFEE: 3Q'C)0
5 at'T I o PJ TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE: ISSUED,BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT. ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
0: 1 It � 10 Z
7 -�L
IXGEND
PEWT SUBMITTED BY
GTE
-s
I
HOUSF
k/ IV IdAll
r'k
q
%
PEDS a
POLES 0
ROAD BORES
OVERHEAD LINES
t.D.UTILITY POTHOLE
UG TREW:HING ----MT—
Ro0s.We
- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - -
— ---------
EOP
it" or ELM ST
------------------------------
CUTS.
a
PEWT SUBMiTTED BY HOUSE
GTE
Ln
r3
Qk
% rit w 3
rt_wcv_
-V IV 6RAUF ldfill
LEGEND
PEDS a
POLES 0
ROAD BORES
OVER14EAD LINES
f.D.UTILITY POTHOLE
UG TRENCHING ---iXT—
IS% lk
R.O.w.
----------------- - ---------- ------
sasrcjz ---------------- EOP
E LM 5T
-------------------------
CUTS.
PERMIT SUBMITTED IBY HOUSE -
GTE
ruwLE rit mf.W 3 0
C.AAACC W41L
9:1
LEGEND
PEDS a
POLES 0
ROAD BORES
OVERHEAD LINES
LO.UTILITY POTHOLE =3
UG TRENCHING ----UGT-
R.O.w.
----------------- ---------- EOP
rc it
4- ILI or
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1 CUTS.
KJ_
00
C)
Ln
C I T Y
of EDIVION DS
For Inspection Call 771-3202
Address of Construction:
RECEIVED SIDE 'S*EWER P E R M I T
�'(S-TREET FILE PERMIT NO. 07591
�U�L C WORKS Fv—IAEDMONDS WAY
M P e A CC 1 TRUNK LINE
Property Legal Description (Include all easements):
7- C)
kO r� &2 VA--VV 0 lqv ik? /U L.,
Owner and/or Builder:
Contractor & License No: 14o h, c—
Single Family Residence
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PL-EL-AASi)E/ READ THE ITE S- ISTED ON THE BACK
Mr, /
cll_el_ (��
I certify that I have read and shall comply Date
with the items listed on the back.
Permit Fee: -0,
Trunk Charge:
Assessment Fee:
Issued By:
Date Issued: t
Receipt No.: (ODS-3
Partial Inspection: &EC_,.Q -r
_ a fZC__C,4aLK rap,[)6_ 3Kj Isflo 14 9 -8 7 Y-4
Comments cr-,PIP6 PROK t+10uSC- Date Initial
Final Inspection Approved: L23-27
Date Initial
Rejected:
eason
** PERMIT MUST BE POSTED ON JOB SITE **
Date Initial
White Copy - File Green Copy - Inspector
Buff Copy - Applicant t
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - ------------------------------ -------------
NEW CONSTRUCTION REPAIRS F� LID No - ------------------ - ASMT. NO - ------------------
OWNER ....... ------------ CONTRACTOR A-u---r-7 ------- 7B.AcA<".ca --------------------------- PERMIT NO.75.')-1 ---
JOB ADDRESS ------ E-UP-A ----- ?L.P-'�C7-o ------------------- LEGAL DESCRIPTION: LOT NO. ---Z-1 --------------------------- BLOCK NO. F��,,,E ONDS WAJ
"I
El-, V, 1-1 T E
------------------------------------------------------------------------------------------------------------------------- I ------------------ I ---------------
e L-P^ ---------------------------------------------
r NAME OF ADDITION PLAsM ----- OF ------ -- ----- --- Rkn-t ---------
G'��9 C-LM PL.
La-T 'ZI
15 . --wi
1 —14.ZS'-.f
7�-ULV- I
A"4t". r--,f
2VOR
4"C�*-wVL
PVPft%.ClDP.
PWW-0001-1 1/75 (REVA 1/78)
le
25
AM 5'0P
CA3. CAP
V DP.
So' -� �-
"MWH . -:I;_
\
Approved:
DATE --- By "L
-- ----- -------------------------
The Citv of Edmonds
Side Sewer Drawing
EASEMENT NO . ........... --------
106-09700 NEW CONSTRUCTION El REPAIRS 0 LID NO. - ------- ASMT. NO - ----------
OWNER ----- �REV.—JUCIURD --- L ....... NANK ------------ ------------- --- CONTRACTOR ---------------- --------------- --------------- -------------------------- PERMIT NO - --------------------
JOB ADDRESS ----- LUI- . STREII ---- ---------------------------- ------- LEGAL DESCRIPTION: LOT NO . ........ ----------------------------- BLOCK NO - --------
PWW-OWl-11175 (REV.11/78)
NAME OF ADDITION
DYE TESTED 01; SEWER
Approved:
DATE............................................ By ------------------------------------------------------------
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
106-09700 NEW CONSTRUCTION E) REPAIRS E] EASEMENT No . ..........................................
Rey . .... Llt ... $Aj!jk
OV*rNER ......... ............ ........................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ..... 6.39 .. m...Elm-Street .......................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
-1
0
NAME OF ADDITION
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE................................................ By ................... ..................................................