641 ALDER ST.PDF10062
641 ALDER ST
0
0
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ADDRESS: co4l
TAX ACCOUNT/PARCEL NUMBER: Oz 7 D 0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: El Conditional Waiver E] Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
N
SEWER LID FEE $: LID #:
SHORT PLAT FILE:' LOT: BLOCK:
SIDE SEWER AS BUILT DA'
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
OTHFI�-1960 95-10A
LATEMP\DS7Ps\Fomis\Street File Cheeklist.doc
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APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
IOS-034SO NEW CONSTRUCTION [I REPAIRS 0 LID NO . .................. . ASMT. NO. .— ..............
OWNER .............. Michael B...Cialla r
........................ . ........... g�� .................................... CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO - - --------------------
JOB ADDRESS ---- 641 Alder Street
- ----------------------------------------------------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
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NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
DYE TESTED ON SEWER - June 16, 1976
By Gary Raymond
Approved:
I
DATE............................................ By -------------------------------------------- j.j7.y6
CY 9 0 - 1 9 9 -
STF(&M�Lt`y U rwillulaub 11
OF -WAY CONSTV TION
rr_J1%1V11 I n ! 0—,>- /^ ---)
erul L Number:
Issue Date: �---2 7-
A. Address or Vicinity of Construction: 641 Alilei St. (9313183)
B. Type of Work (be specific): Install New Service
C. Contractor: Yashiagtoa Nat'l. Gas Co. .
MailingAddress: 815 Mercer St.Seattle, Wii.
State License #:
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. 'r] Commercial Subdivision El City Project g Utility (PUD, GTE, WNG, CABLE, WATER)
F-1 Multi -Family Single Family F] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes QN o G. Size of Cut: x H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. ' Applicant understands and by his signature to this application, agrees I.Aoidahe City of Edmonds harrnlessftom injuries,'damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of U&ipnds, or any of its.departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs-,,YQa'ttdrney fees by reason ofj�qntingfthi� �e4.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A AFD MA TERIALS FOR A,PERIOD OF ONE YEAR FOLLq,!jJyG, WE F)lt 4L INSPEC77ON
M 1 -4�
AND ACCEPTANCE OF THE WORK. ES77MATED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
C17Y FORCES, AT WHICH 77ME A 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 Departm
Work is to be inspected' during progress and at completion.
Restoration is to be in accordance with City Codes., 71-0220
Street shall be kept clean at all times.
Traffi c Control and Public Safety ' all. be in accordance with JQ ty r ulations as required
sh ij , eg 6y' the -City Engineer.
4� - /_ ( , - -, Vbrking day;
All street cut ditches shall be patched with asphalt or City approved material prior to the. end of the
NO EXCEPTIONS.
I ha ve read the above statements and underlphdd <t7e per�m it, "r e�#.and the pink copy of the permit will be available
on site at all timesfbr inspection purposes!�,I,,�;_-_ ,
Signature: '
Date: Xpril 15, 199-1
(Contractor or Agent)
CALL DIAL A -DIG PRIOR TO. BEGINNING WORk
FOR CITY USE ONLY
.............
A�FTEW L: DAYS�::..:. .:: DISRUPTION: FEE/FUND411
...... ......... ...PERMIT. FEE:.
.......................... ............
. ..................
...........
NO WORK SHALL BEGIN
Engrg. Div. 1991
FIELD INSPECTIONOTES Ond .. I I Rq'uite copy to Street De
pi
Comments:
I Diagram:
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
Addendum to City of Edmonds
Right of Way
Permit ADDlication
-Submitted by:
GL4YL.&� CK-IKtOE�s
Engineering Aide
Washington Natural Gas
641 E:z S-F
W"C= L30sv: 9 -31318.5
EDMONDS
-,D�NEW CONST.
XEXISTING
t4l
WNG to window 4 - - 11
Water main depth
unknown "/74
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ff gas main
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815 Mcrccr St- (PO- BOX 1869). Scattk. WA 9811, (206) 622-6767
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water
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gas -
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sewer
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water hydrant
0
water valve