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7003 176TH ST SW.PDFiiiiiiiiiiii 1149 7003 176TH ST SW City of Edmonds /17 C. .1S9Q RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number. �z Z ';�' �> Wue Date: 9—'_-zg A. Address or Vicinity of Construction: 7n o .3 I-FILI;4 B. Type of Work (be specific): —,;/V � _:�L C. Contractor: Zz. 1_4�_�_ g'7'_'1z4 Contact: Mailing Address: 4!�-�rr - Phone: State License #: D. Building Permit # (if applicable): E. E] Commercial 0 Subdivision E] Multi -Family E] Single Family I INSPECTOR: F. Pavement or Concrete Cut : D Yes E]No Liability Insurance: — Bond:$ Side Sewer Permit # (if applicable): El City Project\ 'P T Tt; 1:,y (PUD, GTE, WNG, CABLE, WATER) Other INSPECTOR: G. Size of Cut: x H. Charg(�_$ APPLICANT TO READ AND SIGN INDEMNITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany 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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED BY CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT Two sets of construction drawings 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 trench work 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 and understand the permit requirements and the pink copy of the permit will be available on site at all timesfor inspection purposes. Signature: Date: (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY ,/,I APPROVED BY., R TIME AUTHORIZED: OID FTE DAYS SPECIAL CONDITIONS: RIGHT OF WAY FEE� C20 DISRUPTION FEEIFUND I 11: RESTORATION FEE: T OTAL FEE: — RECEIPT _N ISSUED 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: 8 9 0 - I C) 9 - City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT PermitNumber. Issue Date: _!!�7_';� A. Address or Vicinity of Construction: - 7()03 176 St SW (9615676) B. Type of Work (be specific): Tnatall Rp-rVir-p- C. Contractor: Washington Natural Sao Mailing Address: 1122 75 St SW Everett State License #: 98203 Contac * t: PeZa Floyd Phone: 356-7500 X7596 Liability Insurance: Bond:$ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. C] Commercial E] Subdivision C1 City Project JJ Utility (PUD, GTE, WNG, CABLE, WATER) [:] Multi -Family F] Single Family F] Other INSPECTOR: 114SPECTOR: F. Pavement or Concrete Cut : 91 Yes 0No G. Size of Cut: — x H. Chargq�,$ (_ 2 cuts APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to"'Idth. City ofEdmondharmle88from 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 legalproceedingB 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 COMPLETEO 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. Tz-affic 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 si% at all tirpes for inspecti rposes. /I rff Signature.- zz_�,_k Date: 8-23-96 ("o tractor 0�_A�en_t) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: 11 4WALA RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFrER= 30— DAYS SPECIAL CONDITIONS: &"I:C— — -TXAhJ5, AAAIA) NOK.111 582C, or 5 zi=:z COMMENTS: DATE: DISRUPTION FEE/FUND Ill: RESTORATION FEE: PERMIT FEE: '50' ()/0 TOTAL FEE: — RECEIPT FEE: ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 FIELD INSPECTION NOTES Comments: Diaaram.: (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION 0 YES Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: 0 NO Natu MGM Av4rJvxjlcn Er*W Convkviy Watermain depth A gas main Addendum to: City of Edmonds Right of Way Permit Application Submitted by: n-C!"Mame C' 8A 3 Engineering Aide Washington Natural Gas 1356-7500 X7596 kA) -700-3 176 ST SO -2- Key: -w- Water -G- Gas - -SS- Sever -& Water.hydrant 0 Water valve . I - I Washington Natural Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331 PlatwilGeslm�mmft� I Vate rmain depth gas main Addendum to: city of Edsonds Right of Vay Permit Application pc -cry P-LOYAD Submitted by: IMSOM I C1 IS I 1 3 Engineering Aide Vashington Natural Gas 0356-7500 X7596 Vj 176, SI SO -2, C, U T5 Key: -V- Vater -G- Gas - I -SS- Sever -& Vater. hydrant 0 Vater valve Washington Natural Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331 1-1 DAN- N a t u ON "IS WE= AVAW*VbnEMwWCOTMV Addendum to: Ci . ty of Edmonds Right of Way Permit Application rerry P-LOYD Submitted by: JMIM MI's" 3 Engineering Aide Washington Natural Gas 0356-7500 X7596 J 4% 40109 9LO 5Am. S -46 ------ I 6P Vj -7003 176 ST -2, Key: -W- Water Watermain depth -G- Gas -SS- Sever �& Vater.hydrant gas main Water valve Washington Natur� Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331 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). APPLICATION kr 6�� STREET F112 for The City of Edmonds SIDE SEVVIM PMBM NEW CONSTRUCTION a3—�P 'P A Tl:? Q EASEMENT No . ................................... AQ OWNER CONTRACTOR ... ........................................... PERMT No. ADDRESS -2e.A2 ............. ............................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................ NAME OF ADDITION .................................... \ a ......................... . ............. ............. in \�l Approved: DATE,7 7�,,2 4�-' I -� ....... .... By.. ..... ...... . .............. ....... 3 J f 14- &Olt V lee,4L c7' ' 14� zZle -eez- '_�t 4-1 "'�l CITY OF EDMONDS Call PRospect 6-1107 when work CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for inspection. (No 'nspec' N2 3617 lions Saturday, Sunday or holdays.) SIDE SEWER PERMIT ADDRESS.............................. 70.0-3_-:! ... 17.6tli.-Street ... S...W .............................................................................. ............................... OWNER ......... N.orman_RaS-TRU.55-ejj ......... ................................ CONTRACTOR ........ qpni Safe ............................................................... permission is granted Kar-Ch --- 2.� ................. 19..79., for ..... .................. days to REPAIR or CONNECT a side sewer -,vith City Sewers in accordance with application on file and governing ordinances. ATTENTION IS CALLED TO THE FOLLOWING: NOTE No. I —The owners of the property may obtain ta permit to construct sewer inside property line. A licensed Side Sewer Contractor must r be employed to construct side sewer In s reet area. Do not cover any portion of sewer before it has been inspected. NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line: minimum grade of 2%. No bends in grade sharper than 1/8 will be permitted. condition. Contractors shall be responsible for NOTE No. 4—Trenches in street must be water settled and surface of street restored to original failure due to improper work which may develop within one year of completion. NOTE No. S—It is unlawful to alter or do any othertwork than is provided for in the permit, or to do any work on the main sewer or its appur- tenances except to insert the pipe into he wye.