6918 163RD PL SW.PDFlill iiiiii
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6918 163RD PL SW
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CITY OF EDMONDS STREET FILE ASSET INFORMATION SHEET
12/N EW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
?�PT.
PURCHASE ORDER NO. *PROJECTNUMBER
PURCHASE ORDER DATE PROJECT COMPLETION DATE
COST COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
D/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.
�Ir
00
CD
CITY of EDM VNEET FILE S I D E S E W E R
For Inspection Call 771-3202 PERMIT NO.
Address of Construction:
P E R-J
Property Legal Description (Include all easements):
t/v
V 4//
Owner and/or Builder: Mr 6, 6 1/ ,7 k /V � I I-e �z 5,�
Contractor & License No: A4 p (-;:, c) v /-F lbo -�- 3 Ig 5;
Single Family Residence
LYNNWOOD
Multi -Family (No. of Units !�N E
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Y 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.)
EASE READ THE ITEMS LISTED ON THE BACK
/3
RECLIVLL)
1A
I certify
that
I have read and shall comply
V 1989
Date
with the
items
listed on the back.
JAN
PUBLIC WORKS
Permit Fee: 30
Trunk Charge: 2-5-
Assessment Fee:
Partial Inspection:
'Issued By:
A
HDate Issued:
Receipt No.: �IV7;7
Comments Date Initial
Final Inspection Approved:
Date Initial
Rejected:
Reason Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh-ite Copy - File Green Copy -'Inspector Buff Copy - Applicant
4
I I The City of Edmonds Side Sewer Drawing EASEMENT NO - ---------------------------------- ---------
NEW CONSTRUCTION REPAIRS F� LID NO . .................. . ASMT. NO . ..................
Do ;L Z. %\� E —
OWNER ------------------------------------------------------------------------------------------------ CONTRACTOR .-!�qrnG - - ------------------- ---------- %�O -------------------- PERMIT NO.0.1__q.�-c
JOB ADDRESS ----------- te ;� �, - I - \;-4 - LEGAL DESCRIPTION: LOT NO - ------- OR --------------------------- BLOCK NO - ------------------------------------
--------------------------------------------
- Y
r
417j.c, C�o Q40. I I Pe e, �
t
L
PWW-0001-11/75 (REV.11/78)
-------------------------------------------------------------------------------------------------- ...............................................................
NAME OF ADDITION ..... ....... � % S ............................... I ---------
.YNNVJ.000
Approved:
\43
L
DATE.. . ............ By ...............................
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).
CITY OF EDMONDS Permit No. ?,?- �&2 /
COMMUNITY SERVICES DEPARTMENT Issue Date eF?
RIGHT - OF - WAY CONSTRUCTION PER�STRttT FILE
A. * Owner: Washington Natural Gas CO B. 0 Contractor: Same
N%,y5 156 AV - Name
MR1110eddurg?', WA 98007 Mailing Address
City State Zip
Address or Vicinity of Iq
Type of Work to be Done:L
/r�
City
/�- 1�r & M State License Number
State Zip
447-0700
Telephone Number
691.8 163 PL SW
New
gas service installation /1g
Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
Pavement Cut: 0 Y 0 N
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 or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
0
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
W by City forces, at which time a de6it'oi �ciedi
be processed for issuance to the applicant.
0
0 A 24 hour notice is required for inspection; Please call Public Works: 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.
.e All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
1. understand the above and that this permit must be available at the job site for inspection purposes at all times.
&14A4
Signature: Date: 11/14/88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
>� ISSUED BY: CAI. Olz�z
0_�
Z Time Authorized: Void after 00 days.
0
�j Special Conditions:
Cn
>' N
Amendments:
U
0
PERMIT FEE:
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions: .
X
NO'WORK TO
TO.PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
Comments:
M
Diagram:
(Fund I I I - Route copy to Street Dept.)
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 1985
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