6912 174TH ST SW.PDFiiiiiiiiiiii
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6912 174TH ST SW
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City of Edmonds
RIGHT -OF -MY, CONSTRUCTION
,..PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 6912 174th St SW 40
B. T rk GTE to place, erate, and maintain a buried service
gWofWo (bespecific): wire from exisNinq pedestal #3041 located at 6911
8 9 0- 199 1 th St SW thennnorth to a residence at b912 1/4th ST 5W. GTh to plow
feet and ush one road 16 feet, R.n.W. 35 feet,
Mary A. Bower, Permit Eoordinator
C. Contractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 mobile 388-1358
4312-C W. Casino Rd
Mailing Address: Evergtt., Wa qA?04-1440 Phone: MAry 2nr,/4RA-16;?R nr 710-41 it)
State License #:
D. Building Permit # (if applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. El Commercial F1 Subdivision El City ProjectX)o Utility (PUD,(GTFJ WNG, CABLE, WATER)
n Multi -Family E] Single Family Other 2850-9POO-1-D'B 242310
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut�: D Yes [DNo G. Size of Cut: x H. Chargq,$
Please see attached sketch.
APPLICANT TO READ%'A_W0 SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees the City ofEdrnond8JW- '7,%y-ries, 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 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 inspection purposes.
Signature: John H.'Stewart Date: October 31, 1996
(Contrac-t6r or Agent) Sec. Mgr. -Access Design
CA.LL DIAL —A —DIG PRIOR TO BEGINNING WORK
FOR CItY USE ONLY
"PROVED BY- RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND Ill:
SPECIA-L CONDITIONS: A-. RESTORATION FEE:
PERMIT FEE:
TOTAL,FEE: __!VT" 00
COMMENTS: RECEIPT FEE -
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diaoram.:
A 1. (Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES
Date:
Date:
MIMI
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0
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POW SUBMITTED BY
GTE
LEGEND
7-
PEDS a
POLE'S 0
ROAD BORES
OVERHEAD LINES
1AUTILITY POTHOLE CM
UG TRENCHING --UGT—
Jkj c (L -Tr, 1: 0 F R. 0. W.
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------ --- ----------------------------------------------------- Eop
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CUTS.
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ch LEGEND
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PO'MIT SUBMITTED BY
GTE
W-k V, , 1 4
= ------- /- - - --- - - - - - - - - -
-----------
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PEDS 0
POLES 0
ROAO BORES
OVERHEAO LINES
1.0. UTILITY POTHOLE
UG TRENCHING --UGT-
RoOsWe
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �op
17Y S7'—S U/
------------------------------
CUTS,
CITY OF EDMOND ORKS DEPI
SIDE SEWER PERMIT
8 9 0 PERMIT [qO 3654
Address of Construction: 6qlz- 1-7 4/7f—
Property Legal Description (Include all easements): 4-P,-t,-rV ve< 4-
60 and/or Contractor: T—)e-f
State License No. �qwvyetf_
'0 Single Family
C3 Multi -Family (No. of Units—)
11 Commercial
F-1 Public
I cert
as ir�(
I �,,- vrzl,
Building Permit No
Invasion into City Right-of-Way:*95Nc
RW Construction Permit No.
Cross other Private Property: 9 No
El Yes
11 Yes
Attach legal description and copy of recorded easement
at I e read and shal cc ply with all city requirements Date
c oJ
f
'Le,ackofthe er itCard.
the
,d Pt �a k _
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
FOR INSPECTION CALL 771-3062;- PUBLIC WORKS DEPT.
.�0.00 c9.**A19!,0 -7
Permit Fee: Issued By J26
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
Partial Inspection:
Comments
Date —Initial
Reason Rejected: Date —initial
Final Inspection Approved: Date lnitial(��,
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant Revised 3190
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City. of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
t
V
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - ---------------- ...........................
1%
NEW CONSTRUCTION REPAIRS 25 LID NO . .................. . ASMT. NO ...........
P, /
OWNER................................... ....................... .................................... CONTRACTOR .................................................................................... PERMIT NO.
1 2,
JOB ADDRESS .. . . ............ . ............ ........ LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
4
PWW-000 1 - 11/75 (R EV. 11/78)
................................................................................................................................................................
I
NAMEOF ADDITION .......................................................................................................................
I -14-114 5—\ - -11 - 0
3 A.Y,145e-
0
\N 4." 3,1)"r
tb.? %, DZ't-F .
Approved:
DATE ............ ..............
Z
0
W
V)
U
FMOM
GIN
01TY OF EDMONDS L
COMMUNITY SERVA09 fiL-el-> s-c
RIGHT*_OFWAY CONSTRUCTION PERMIT
A. 0 Owner: Washington Natural Gas Company B. 0 Contractor:
Name.
815 Mercer Street
Mailing Address
-Seattle WA 98111
City State Zip
2-9- C4 t
Permit No. 70 - �2��
Issue Date� / /_ /45�_ 15;1 (-) -
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. e Address or Vicinity of Construction: 6912 174 Street Southwest
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
El Commercial El Multifamily 9 utility
E. 0 Pavement Cut: fR Y 0 N F. 0 Size of Cut: 2 X 4 @H 2 0
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind=cription�hAtsoe,,�ef�( forlieeiCor' unforseen, that may
be made against the City of Edmonds, or arty of its d me r emplo e Is inc'Ml6ing 6r not limited to the defense
i6sgi Mson of granting this permit.
of any legal proceedings including defense costs, court and ;ittbrney
CICS,
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 the applicant. I .
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature:
Z, M "j"a 0 11 1 M-4-4 L
Owner or Cont ractor
Date: November 2 1990
This Permit Must be Posted at the Job Site For Inspection Purposes'
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: PERMIT FEE:-V:?o ta= 4C2 A,(
Time Authorized: Void after an-6 V ()-TH 4a*&. Restoration Fee:
Special Conditions: Receipt No.:
RELEASED BY:
Date I/L/ " 0
Fund I I I Fee:
Street Cut Dimensions:
INSPECTED BY
Date
NO WORK TO BEGIN PRIOR TO PERMIT, ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept*-)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 11 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 19
Washmg2on
Natwfil GaOm�—
bq12 �4 Sr(-5m/
WNG to window
CX—,S t �in
proposed
" gas main
— Addendum to:
City of Edmonds
Permit Application
Engineering Aide: Kerry Walsh
Washington Natural Gas
622-6767 x2761
water main depth unknown
1 7.
G,
Key:
:s: saviitary sewer
w water
-g- gas
water valve
hydrant
,"-Y/I
815 Merccr St. (P.O. Box 1869), SeattIc, WA 98111 (206) 622-6767
so APPLICATION
The City of Edmonds for EASEMENT NO - -------------------------- -----------
SIDE SEWER PERMIT
CONSTRUCTION E REPAIRS F� LID. NO. -llfi ......... ASMT. NO.
OWNER -4�75
.................................. CONTRACTOR --- SAE� ... �.. PERMIT NO. !��4 M-5:7c.--
JOB ADDRESS -- -------------- LEGAL DESCRIPTION: LOT NO - ------------ ...................... BLOCK NO - ------------------------------------
0
................................................................ ----------------------- ---------------------------------------------------------------
NAME OF ADDITION --------- - ..... -------------------------------------------
Approved:
DATE ........ -------- By --- --------------- 1P,
V -
-77
71
F EDMONDS SIVE 'ISEWER: PE MUTT
WATER -:,SEWER, DEPARTMENT,
P.ERMIT
Call. 17.5-2525 for side sewer inspections; BEFORE-, covering any portion of the construction
Inspectio n will -be provided' within. 24 hours after requst. NO Sat., �Sun., or I holl day Ins , pections.
Oji�1'6CAIT16N.46f� NSTRUCTION ........ 6LC
') 12 174th Street S.W
............................... 7 .......................................... .................................................................................
........................................................................ I ............................... ..................................................................................
ot. S.. Che.rry Crest.
.................... ...... .................................................
.......................... ...................... ...................................................... ..... ............ .....................................
B 'DER..C�017,ART fi FMS ................... I ............ .........
............. .......... I ........ ;OM#7NER AND/OR UIL ............................ ...........
Sewer, -21607,2nd Ave. S. E. Bothell
CONTRACTOWS"NAME1 & ADDREss.jjpj.t.e.d .... Plan b in a (I .................................................. 7 ............ ........ .............................. .........
.. ... .. .. ... .. .. ..............
F.Orinis4lon,'Tis,grdute(l...�,,..�,..V-�11)'--r.11 qr..Ir ...... : ...... 19. -�l Et'. f
................. or -repair and/or connection of -a; side sewer to the City sanitary sewer -
M
s� Vn, M" kecoidance�,Witli, City of.Ed ' onds� (;rdinances.
IS1,,CALLED, TO, THE FOLLOWING:
N No. I=The. owners:,of Abe. property may obtain a permit, to construct sewer Anside property line. A licensed Side -Sewer Contractor must be employed, to4construct
I -street,, area%i Do not cover any portion of sewer before, it has,been inspected.
Ile sewer� in
Nol. 2—All 'work: perfor'm"'ed ln', city requires, an Invasion' of Right-of-W Permit obtainable frorn. thii -City Engineer's office.
NOTE. No.,:.,..3�', Obtain'full Information regaxding Ordinance 11.16.030 and! Regulations govern�tng side sewers when- you get; permit.
1�6Z. N8- 4�'Tp'bf,'.ide s"�w_er.m�st haveat least 30 inches coverage,ai property 11 , zib and 12 Inches Inside property I . ine; minimum,grade of. 2'%. No;be nd : s In.,grade'
��shorije�-tfia�nLIA�'�vill-be.permitted.
'N'O'TE;No,� 5-�-Trcnches'in st I re , et,,must be,water settled and, surfa:ce of street restored to original condition. Contractors "shall be' -responsible for failure, due to -improper,
?..,,iork'�vhich.r�E�i,"develop, within one year of completion�
i�6TE No. 67,-it`_-is ..Iaw'fd�'.io'�aiter,o r dwany other work than Is provided for I n the permit,, -or to do any work on the main sewer or its appu rtenances except to in-
Sqrt.the pipe iniothe wye.
DISAPPROVEDDate ........................................ By ................ Date ........... ................ By ................. Date ............... . ................. MY: ...............
�P'PROVED Date�......, ..... Z;�.� ...... . ...... ............ By ................
....... . ..... ................................................................... .
Reiharks: ......... .................
...................................................................................................................................... ...................... ......
................................................................................................................ .................................................................. ................. I .................................... .........
BOT,14 Permit," Cbpies' MU ST Be Signed By Owner of, Firm -Performing Construction PRIOR To Request For Inspec6on
hereby,' -certify,that the sid& Sewer installation, donstructed under this,:permit
_6 oi�i`tlr�ietlng -Firm� Performing Construction)
.4 �x
'wne
wag� stall6dln Mordali66-with allgoverning ordinances of thet City', of'Edmonds.'.
Dated,-thfs ............................. (lay. :of: ........ ......... M .................. ........
-1 ci� Bl�kOiE' er,,'E];, "Gas []v -Telep4one,
C JVat Power- E]� Sower Ej;,'.� Other"E].-
ie you dig: for
,- Tho City of Edmonds
OWNER _4
JOB ADDRESS
a
APPUCATION
for
SIDE SEWElt POtAUT
NEW CONSTRUCTION [-] REPAIRS E]
---------------------------
--- ----------------- ------------------------------ -------
EASEMENT NO - --------------
LID NO. ----4-V--_ASMT. NO. 4-1a
CONTRACTOR
&,-,C1 -.e,;) -------- PERMT NO.
LEGAL DESCRIPTION: LOT NO - -------- -------- ------------- .. BLOCK NO - -------------
--------------------------------------------- --------- -------------------------------------------------------------------------------------------------------
NAME OF ADDITION .......
x ----- - ---------- ----------------------- ---------------------------
Approved:
RECEIVED
DATE.......................................... _ By