7011 165TH PL SW.PDF916
7011 165TH PL SW
City of Edmonds,
RIGHT-OF-WAY CONSTRUCTION
PERM -IT Permit Number- -,2
Issue Date:
A. Address or Vicinity of Construction: 7011 165 01 SW (9601345)
B. Type of Work (be specific): Insta1l Semice
C. Contractor: —Washington NaturalL Gas
Mailing Address: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 447-3284
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. []Commercial [-]Subdivision, El City Project [ja Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family E] Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut [I Yes [ENo G. Size of Cut: H. Chargo�_$
APPLICANT TO READ AND
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the!City ofEdmondg harmless from injuriesi damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe made agai'"t, the City of Edmonds, o.r!any,'6f its 4 artmentsor
employees, including or not limited to the defense ofany legalproceeding8 including defense costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLL WING)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 THE APPLICANT.
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 duriiig-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�t�ir inspVctlion purposes.
Signature: Date:
T&Wra`ctor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY [Tqv. nNI.Y
APPROVED BY: WS14 C-%A-t
TIME A UTHORIZED: VOID AFTER rL DAYS
SPECIAL CONDITIONS: N - ek
RIGHT OF WAY. DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
. I PERMIT FEE:'—'
TOTAL FEE: L30 (9 0
COMMENTS: RECEIPT FEE:
DATE:, ISSUED BY-
T 4�-
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION Y ES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
A AL- —IL-2—
w PAM I
NaDU M Gas'
AMWjWXjtcn Energy Gortrany
Watermain depth Q/4,
gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
Iq%A-7%nn Y7%QA
J CB qGO I S4G
r,4 0 CJ-J -rc
Key:
-w-
Water
-G-
Gas
-SS-
Sever
-&
Water hydrant
0
Water valve
Washington Natural Gas Company
1122 75th Street SX. 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
The City of Edmonds STREET
FILE
for
SIDE SEWER PERMIT
EASEMENT NO . ..........................................
NEW CONS TRUCTION REPAIRS
LID NO . .................. ASMT. NO . ..............
OWNER t4 .... .................................
CONTRACTOR ....
........... ...... ......... PERMIT NO7�.- ...
JOB ADDRESS .. ...... F7L—. 15 - 'v�-
-15 ..................... I .............................
LEGAL DESCRIPTION: LOT NO .
........... cl�!s
..................... ..... BLOCK NO . ....................................
��7-` Ea" r-, I
�ca c) - L
-q4l PL- -'S. LAJ.
!2� ?LL��
C>.E 9
C�
....................................................................................................... ..........................................................
- \t4
NAME OF ADDITION ..... \,O-E - - ......................................................
T--
fftf-+er
Z,9 P PL.
(4. F.,
T-
s-4
Approved: / z
D,! 5 7 ...... By -----------------
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uc.r*7" I
Y,--0F:-.ED.MA NID -WEIR--," PERMAIT
-CUTY I & --_:,:-Sj0EW
-ENT*
ATER,�-SEWERDEPARTM
PERM
IT
n
(qail� ',7,,75rz5z5, for. side sewer' lnsp�etic,n�. BEFOI�E, coveripj, any portiom of the constructio
will -be provided; within 24 Irours,after�reqbr n.:'.or holiday% I..
Ins-o�ctloft� 146. Sat_. Su. pections.
ADDRESS OM,-i) 1CO' ST CT ....................................... ............ .....................................
LOdkn Y N RU ION ... ......... .............
�r��'jl�ItOPEP.T,Y.'1;19GAIL,',DEsciti-P.1-10N ............ .......... 18k- . ................ ... ...... ....... ...................................
..................
................................................... ........... ............. ............. ......................................... .................. .............................................................................. ... ................
AND/OR BUII ...... t�
.......................................... .............. ... . ...... ................. ...... ............ ......... . ..................
6N.TRA AME& ADDRESS..
CTOR!S M., ............ .......
�11 ................... �7 ..... . ........... ............................................................. .
k Permission-N4 ''Ity
l, ....... for repair andp or,leonnection of,a Side�.sewer to e:�ei sanitary sewer
'tem im accor ance ances.
Js d -Nvith d7t�,of, Edi;a"' ordin
_A-,-�ENTION IS CALLE]5-T*6'THi,- FOLLOWING:
NOTE No. 1—The owneri,of the propefty,imay obtaiiL a permit to, construct,sewer inside� property llne� A lic,ensed,Side !36wer'Contractor;must,be employed, to,iconstruct
side sewer, in��street, area. "Do,not cover any portion of sewer� before It ha's been, Inspected� -
'P�QTE No. 2—All work performed in city right-of-waylrequires an Invasion of I�ight-,of-Way'.�Permi.�',�btainab'l���irorii'the City Enjineer's offic6;,
NOTE No_3�6btaln fuIf,�'4Wf6rmatIcn regarding Ordinance 1,1.16:030,�rtnd R&gulation�, govern ng�sldej,sew.ers:�When, you get permit..
N6:iE No��'�'—Top.�of..slde isewer must,have at least 30: Jnches!.coyerage at -property line and 112, inches lnsfdb property line; minimum� grade -of 2%.. No�lbends In grade
'A wlll� be permitted�
N6T'E No 5--Tr . enches in-street,must be water settled . and surface of street restored to original condition. Contractors sha.11 be responsible for failure . due i. improper
work which,'may develop within one year of completion.
NOTE No..6—It is-unlawful,,to,alter or do any other work.than is provided for -in the permit, or. to do any, work on the main sewer or its appurtenance . a.
-sert the pipo4nto the Wye.
DISAPPROVED E] Date ........................................ ................ Dat6..:..,
By. ............................... By: ............... Date ..................................... ............
APPROVED '�Dat� .... \.- ..L By ....... .............. .............. ........................ . .................
........... ..............
%
.....................................................................................................................
Remarks:
............................................ ....... : ........................ ..
...........
.................. .................................. ........................................................................... ...................................................................... ............. .......................
Tit on-s
1 oples. , ST Be Signed' By Owner, of Firm Perkormiifz C' triiefion PRIOR, To Request For Inspection
P,
Y,
0 o t acting Firm Perf on)
. .........
... ............. .... ..... hereby' certify, that the,side-sewerJnstalldtion consti-iieted uhfierAfils-peimit
wrier of' ,n� g on. rue I
�zxis'Ins.611ed iXabc r e with allgoverning ordinancesof theCity of'Edmonda.,
Dated this .................... ::� ........ day �of ....................
..........................................
Check, BEFORE yoia:. dig lor:, W er Tele h
at .bWer E],, Sewer [],1, Other. E]: V,V
pione,]Ej,
J -j
The City of Edmonds
.. .. .......... a -------
OWNE1 te .. -
JOB ADDRESS ---- 7 --- OIL ------------
AMCATION
for
SIDE SEWER PERMff
NEW CONSTRUCTION L�� REPAIRS
-------------------
-------------------- ........
CONTMRACTOR -� - -- ---- -- --------- --- -
X,-Z",T-s �J�
LEGAL DESCRIPTION: LOT NO - ------
................ — ------------------------
NAME OF ADDITION
]BASEMENT NO - --------------------------------------------
LIDNO - ------------------ ASMT. NO. � -----------------
-TiNINDIX-5 -_-" M
--------------- - PERMIT NO.eqfte -----------
BLOCK NO - ---------- -------------------------
---------------------------
..... ... ....
/ ------------ 7 ------------ / ----- �ag
. ......... .. zt) -----------
x
Approved:
DATE ----
BY--------------------------------------------- Yi7yff
C I T Y 0 F E D M O-N D S
- PUBLIC WORKS DEPARTNiNSTREET FILE 7 7
Routing of Building Permit, Plat, or Subdivision Applications
Proposed Property Address:
7011 165th Place S.W.
DEPARTMENT
COMM[ENTS
INIME-
& DATE
IVA T E R
S E W E R
77
S T R E E T
B U I L D I N G
OR
P L A N N I N G
ADDITIONAL INFORIATION:
9
10111/76
BUILDING DEPARTMENT Applicant Fill
USE
ZONE
PERMIT
NUMBER.
Inside Heavy -Lines
TERMIT APPLICATIOR
JOB
A DDRESS
7
NAME JOR NAME OF BUSI,NESS 1
VARIANCE OR CO. USE 110'.
ADB NO. IGHT
W
MAILING ADDRESS
A 1
z
;z
PROPOSED YARDS
-OVERAGE
0
CITY TELEPHONE NUMBER
FRONT
SIDE
REA&
. ;(, 1hinkir ;lrrr
-7 d' 7 0-'V44
SIGN AREA
PROPOSED
ENVIRONMENTAL REVIEW
z
ALLOWED
0 COMPLETE 0 EXEMPT
NAME
REMARKS
z
U
W
j
CL
ADDRESS
PLANNING DEPT. APPROVAL DATE
U
CITY
ONE NUMBER
0:
LEGAL LOT
LOT.AREA.
SUBDIVISION NO.
0 YES [:1 No
NAME.
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
ADDRESS
0
U
COMP. PL . AN ST. R /W FT.' FT.
2:
CITY
TELEPHONE NUMBER
REMARKS
z
0
U
STATE LICENSE NUMBER
CITY LICENSE NUMBER
JCHECKED BY
Z
W
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY WORK
R E Q'D. YES El No
R/W P MIT REQUIRED W
YES 0 NO
z
Z'
W
WIRING REO'D. 0 YES ONO
TYPE CONNECTION ESIVIERIFIED
Y
BY
Y SEWER N
SANITAR 0
U
0
W
SEPTIC SYSTEM
APPVD BY CITY ENG. El YES
D
7ERMIT-NUMBER
REMARKS
W
J
METE S ZE
SIZE
CLEARANCE
HECKED BY
ISERVICE
Z/W
W
GAS
N Ew RESIDENTIAL E] LINE
FIRE ZONE
TYPE OF CONSTRUCTION
A DO NON-RESIDENTIAL SIGN
F D DEMOLISH RETAINING
WALL
r_1 ALTER EXCAVATE FENCE
R OR FILL 111 X —FT)
]COD
SPECIAL INSPECTOR
REQUIRED
El YES 0 NO
REA
1A
JOCCUPANCY
GROUP'
JOCCUPANT
LOAD
F:
PLAN CHECKED BY JHIS SITE IS LOCATED IN THE CITY rd
F� R EPAI R PRE -MOVE Sw . Im
INSP. El POOL
OF EDMONDS. LOCAL. SALES TAX
SH OULD BE CODED 31,04,
REMARKS
NUMBER. OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
VALUATION FEE
z
PLAN CHECK
0
NO.
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
PLUMBING
W
HEAT & GAS LINE
m
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL