7016 179TH ST SW.PDF111111111111
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7016 179TH ST SW
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
Permit Number. qq,
EET FILE PERmT. - , ;Z 41 Ly
Issue Date:
A. Address or 'Vicinity of Construction: 7016 179 St SW 9417485
B. Type of Work (be specific): Install New Service
Washington Natural Gas Company
C. -Contractor:
Mailing Address: 815 Mercer St Seattle WA
98111
SLte License #:
A:
lj�. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F.-J, Commercial E] Subdivision 0 City Project ff] Utility (PUD, GTE, WNG, CABLE, WATER)
El SingleFamily
E] Other
INS,
INSPECTOR: 4toA
PECTOR:
--2 2- --4-4
kvement or Concrete Cut: D Yes UgNo G. Size of Cut: x H. 6argq�_$
APPLICANT TO READ AND SIGN)
W
INDEMNITY.- Applicant understands and by his signature to this application, agrees to h d, fEdmonds ha fqd:mages, 0
' 0
it
'Iyhe City of Edmon
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ag alliftn4�ftf tments or
"6osts, nd attorney fees by reason' ofgranting this permit.
employees, including or not limited to the defense of any legal proceedings including defense
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA&RIOD OF ONE YEA FOLi.-OWING T�HE FINAL
V ,
!NSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION F4ErS)W bP,713R�HELD UNTIL THI�RINA� STI�FFT PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BEPRO&-SSED POR ISSUANCE TO iHEAPPLICANT.
Construction drawing of proposed work required with/perinit application.., I
+
A 24 hour notice is required for inspection; Please call tHe Engineen"jig Division, 771-0220 Q-q
Work and material is to be inspected during progress and at comol6fion.
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 ions as
�4t;Zr ulati , required by the City Engineer.
rea Taterial prior to the Ad dMAofking.day;
All street cut ditches shall be patched with asphalt or re
NO EXCEPTIONS.
Ihave read the abovestatements and understand the permit requirements andthepink copyof thepermit willbe
available on site at all times for inspection purposes.
Signature: Date: May 17 , 1994
(contractor or",,C,-en1J-
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND Ill:,,
SPECIAL CONDITIONS: AIQ 6(1-rl' C70 RESTORATION FEE-
41 -�RVRMIT FEE:
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng�g. Div. 1991
FIELD INSPECTION NOTES
C omments:
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:
Addendum to CitX of Edmonds
Right of way
Permit Applicaiion
_Pub itted by: MITCHELL S--LANKFORD
Engineering Aide
-701 G Washington Natural Gas
# .' -521-'5246
ING to window
W ain depth
ut4nlo��wn
S- 11 gas main
I K-Ccz::> c-c7—\ ::7>
-2, 4 0
Xey:
-w- water
-g- gas
-ss- sewer
-&- water hydrant
C) . watc!--.- valv'e
315 'Ac!rccr St. (I). ):�,x 18'19), ScAtt)-, WA S U I I j%'206) 622--767
—C
. I sq,�
PERMI NO: 1111
City -of Edmonds
PERMIT EXPIRESIM
SIDE SEWER PERMIT - t.
(.04
Address of Construction: �7o I !e 1:7!� LID 0
Property Tax Account Parcel No. 1 006 GO. (_0
Attach copies of all access and ility easements Verified and Approved b
Owner and/or
Contractor License 4:
Single Fam ily
Elmulti-Family(No.of.Units.
n Commercial (No. of Units
Public
ng Permit #:
qqscL
Invasion into City *Right -of Way: 0 Yes
*RW Construction Permit
Cross other "Private Property: El Yes ',L;l �q.
"Attach legal description and copy of recorded easement.
ontractor
Owne
Owner or contractor signature land acknowledgement statement: Date
By signing for this permit I certify that I have read the"City.'s public handout entitled
ide Sewer Specifications, and shall comply with all City re'quirements outlined therein.
CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION.
9 FOR INSPECTION CALL 425-771-0220 extens.ion.'329 2
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
FOR OFFICE USE ONLY
....... ... . .......
Permit Fee Repair Fee Issued B
Trunk Charge $ Date Issued-V
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.'
Job Site Ready YES NO Date: 'Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
CTIO
FINAL INSPECTION APPROVED: Date: (,gl 5101 1pitial: As-bUilt,to Stre'.0,File:
15, PERMIT MUST BE POSTED ON JOB SITEt,
White Copy': File G I reen Copy: Inspector Buff Copy: Applicant
L;t�mp;bldg;forms-,ssperTnitjlg4/OO.
t179TH
ST, SW
C/o
6" PIPE
WYE
7
14'
GARAGE
51
2'
CITY OF EDMONDS
SIDE SEWER
AS -BUILT
ADDRESS
7016 179TH
ST, S,W,
PERMIT
NUMBER 9493
HOMEOWNER xxxxxxxxxx
CONTRACTOR
FERRINVILLE
DATE 06/15/01
DRAWN
BY
ISMAEL ABILA
014, Pq 41 S - (J) -
4:V-'r(4q QS-
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