7010 174TH ST SW.PDFiiiiiiiiiiii
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7010 174TH ST SW
8 9 0 . 199 -
City'of Edmonds c TO F E T
R5dU'9yft-0E-WAY CONSTRU
QA
FILE
tj �; 1 2 '1 IZ rrinIV11 JL Permit Number: 91-3-7-3
ENGINEERING Issue Date: / C) — ;:)—D— — �L
A. Address or Vicinity of Construction: 7010 174 Street Southwest
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Gary Swanson
Phone: 224-2080
Liabilitv Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. -FJ Commercial Subdivision F1 City Project X] Utility (PUD, GTE, W`NG, CABLE, WATER)'
F-1 Multi -Family El Single Family F-1 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : El Yes FX]No G. Size of Cut: x H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds haimlessftom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may,47n—j-hde against the City.of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings includi de e' e'costs, a,�d auo;-n—', feet by reason of granting this permit.
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THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ND MAE 09 'R FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORA77ONFEES WILL BE HELD UN77L, THE FIN14ZS7REET 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 Department- 771-3202.
Work is to be inspected during progress and at completion. 0,
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 and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: m6m"4AO Date:' October 5, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO. BEGINNING WORK
...... ......... ...... RECEIMNO;
......................
D E: ISSUED, M).
AT
NO WORK SHALL
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
1,
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:.
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
W
N tu I Gat
AVV-hngton E--w C-Tparry
--70 �C-:>
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
F74 '��C Washington Natural Gas
622-6767 x2761
pager 995-6914
MR,
Vlyn-wa
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2
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
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
sh*own 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
a
The City of Edmonds for EASEMENT NO - --------------------------- ------- --------
SIDE SEWER PERMIT
CONSTRUCTION REPAIRS F
V LID NO. --------------- ASMT. NO.
OWNER -------------------- ----- CONTRACTOR -------- —=5.
------- .... 1�� ------------ PERMIT NO.
JOB ADDRESS ------- ----------------- LEGAL DESCRIPTION: LOT NO - --------- (Z-� ----------------------- BLOCK NO - ------------------------------------
NAME OF ADDITION ..... —LZ-� ��— ........... .........................................
Approved: /I',— z
-------- By -------- A—,�7�w
of Edmonds
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9
EASEMENT NO - ------------------ .........................
LID NO . .................. ASMT. NO. --
OWNER --- - -------------------------------------------- CONTRACTOR ------ ----- PERMIT NO.
JOB ADDRESS ....... t>�A ......................................... LEGAL DESCRIPTION: LOT NO . ............ -;; -- --------------------- BLOCK NO . ....................................
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION F1 REPAIRS
------------------------------ -----------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION -------- ----------------- (r
......................................
Approved:
DATE............................................ By --------------------------------------------------- j-j7,jg
Y�
7 Y -OF: EDMV '10NIDS -SIDE SEWER PERIMAIT
ET
W1A*T1Et'-'SE -DEPARTMENT,`
'PERMIT A
Call 775-2525 for side sewer :inspectibns BFCORE, covering any portion (if the constr' tion: 7.
(Inspection will -be provided within 24 4h6urs aftir requst. NO �Sat., in'p uc
'Sum, or holiday, s ections.
Tr4
ESS LOCATION OF%CONS1`RUCTION ......... . .......................................
DR
.............. ............ ...................................................
LEG'Aii! DESCRIPTION . . ................................ ........ 4;�
PROPERTY
....................... . .....
............... .......................................... ...........................................................
............. ................................
.......................... 'OR, iBU
........................ OWNER AND/ ILDER...
.. ..................... . .'r, ....... �.: ...........................................
4
.............
CONTRACT,OR!8'N1AM1K* ADDRESS ...... ....... ....d .— ... lfi�;�,�,
............ ; .. . .... ........
............................................
.............. 197*"...,, for repak,andVor connection, of a side sewer '�,�h
Permission Is granted .... .................................... �toe 0"'.461ty, sanitary:
'em, in accordancerwith, City.4, Edmonds. ordinances.
ATTENTION.IS CALLFD1TO%THE',FLOLLOWING:
NOTE. No. 1—The owners. of the property may obtain a permit to. construct Inside, property line., 'A licensed, Side, Sewer,Con acto m e
tr r, uii� be', mployeck'6, construct
side sewer.in streetarm. Do not cover;aziy, portion' of' sewer beforeAt 'has beem inspected.,
NOTE No. 2—All work 13'eiformedJn, city right-of-way requires,,an Invasi -of-Way Permit �obtal nable -'from, t e CIty.Erigineer?s,4ffice.
on.,of'Right h
NOTE No. 3—Obtain f ' ull 'information regarding Ordinance: 11% 16.030; and, Regulations, governing side,.sewers,when, you get permit..
NOTE No. 4—Top of slile�iewer�must have,at least 30 inchmlcov6rage-at woperty line and,,12 'Inches :Inside, property line; minimum, grad6..oV2,7v.,' No bends in grade
sharper,than 'A -wlll�,be permitted.
NOTE No. 5--Trenches� In street must be water settled an& surface,,of street restored
work which, may develop within one year of completion., to original c6r�dltlon. Contractors shall be responsible for. 'fallure due to Improper
NOTE) No. 6—It is unlawful to alter or do, any other work than is� proovid6d, for In the permit,. orAo. do any. work on th*e'main, sewer or its appurtenances except to in-
sert the pipi into the wye.
DISAPPROVED Ej Date ... .......... ..... By ................ Date ....... ............... Date ............. ...... .
. ...... Ayl-� By ................
. ... By ...........
.............
. ........................................................ ........... ..................
Remarks& .............. ---------------------------------------
f Firm, Per forming Construction PRIOR To Re c on.
BO' Permi es MUST, Be Signed,By OWner:o
quest For Inspe tj
I, . . ..... 'hereby-,ceirtify that,the side sewer ins tallation.'construct . ed- under this.'permit
(Owner of Contra �iy�r
ti.g I;',
was installed in accordance'wi . th all governing ordinances, of',the City. of Edmonds:
Dated............ ....... Y, *;of .......... .............. ....... 1191 .........
. " . . I I - I I : ................. 7-11 1
Powe e her-[]�..
er,,,E], Ga, 'Ot
Check,BEFORE you dig'. for:' Ayad
ew r:
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STREET --FILE
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P:"PT. (ITC!, LIST
Strcct Pight-oF-Way ExistinF-34?l T;u
Access Fiscmcjits Existing
Utilitv Fascment J1,cistincy QALP
Lot Pcr St il) d i v; si on Plat
Sitc Plm (Icc!.ecl for Accurac%,
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BUILDING DEPARTMENT
Applicant Fill
PERMIT
ZONE NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS 7o/c 7 q-
NAME (OR,NAME OF BUSINESS)
/6-1 h a /V �7
0
LEGAL LOT
49 yes 0 NO
LOT AREA
SUBDIVISION N
PL.
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0
MAILING ADDRESS
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CITY LEPHONK NUMBER
I/ 1-7-L 0
STR LET R tW
EXIMINIG STREET R/W f-") Fr. DEFICIENCY THIS PROPERTY
COMP. PLAN Sr. R/W 3 PIT. FT.
NAME
REMARKS
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ADDRESS
CHI;CKED BY
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CITY
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TELEPHONE NUMBER
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STREET AND/OR UTILITY WORK
REQ'D. 0 YES 'FNO
R/W PERMIT REQUIRED
C3 YES t9NO
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NAME
UNDERGROUND
WIRING RE Q'D. 4RYES ONO
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ADDRESS
TYPE CONNECTION *YES IVE"'
SANITARY SEWER
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CITY
TELEPHONE NUMBER
SEPTIC SYSTEM YES
APPV'D BY CITY ENG.
&NO
PERMIT NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
A T )7---t - / e V
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BUILDING SUPPLY SIZE
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F.
REMARKS
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SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEM
ADB NO.
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REATR
LOT COVERAGE
GAS
NEW RESIDENTIAL LINE
DADD NON-REIIDENTIA] SIGN
EJ DEMOLISH R TAINING
WEALL
FALTER EXCAVATE FENCE
OR FILL I—
F� REPAIR PRE -MOVE swim
INSP. POOL
FIRE ZONE
TYPE OF CONSTRUCTION ICODE
I
SPECIAL INSPECTOR AREA
REQUIRED
YES NO
—
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
z
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NUMBER OF ORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
"2
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PLAN CHECK
NO.
BUILDING
VALUATION
FEE
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PROPOSED USE
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL,
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SWIMMING POOL
N
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