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9001 OLYMPIC
VIEW DR
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City of Edmonds
G - F-WAY .CONSTRUCTION; C, 3
S PERMIT. ,q''' Permit ENGiN ,4 ,b
Issue Date:
A. Address or Vicinity of Construction: lt�t00 Olympic View Drive
B. Type of Work (be specific): Install New Serveie
890 19�
C. Contractor: Washington NAtural Gas Company Contact: Gary Swanson ;..� H,
Mailing Address: 815 MBrcer Street, Phone: . 224-2080
Seattle, WA 98111
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
,�f i•L.
Side Sewer Permit # (if applicable):
f .? - 1 t-- i /
E. ❑ Commercial ❑ Subdivision ❑ City Project Pg Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: Wlt t�
.t
F. Pavement or Concrete Cut : ® Yes []No (11 G. Size of Cut: x H. Charge $
2x4@Gas
APPLICANT TO READ AND{SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that maybe --made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings inclruufin efense�APERIOD
u, and "ttorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA FOOF ONE YEAR FOLLOWING 771E FINAL INSPECTION
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL S7REET PATCH IS COMPLETED BY
CITY 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.
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
out site at all times for�inspection purposes.
A
Signature: Date: December 16, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
. . NO •WORK
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund III - Route copy to Street Dept.)
Comments:
Diagram:
9
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. P
w
Washington
Natural Gas
AW&JVQW Energy GIN
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Addendum to :
Submitted by:
City of Edmonds
Right of Way
Permit Application
Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 494--" 141
a
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
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can PRospect . 071107 when work -
Is ready for. Inspection. (No inspec. 0 Q "�
tions"Saturday, Sunday or holidays.) =' N. (� 1
ADDRESS.... ........... 9.QQ.1_01.ymp C...Vi.ew.._Dri.ve.............................................-.................._.........._.............................................:..
OWNER ....................If,hn..0..... Bakken ..................................... CONTRACTOR ....QW_rX r..............................................................
PerillisSion is granted ..._..O ob ............1 19...7Q, for ........................ days to REPAIR or CONNECT a side sewer
witlfi'City Sewers in accordance with application on file and governing ordinances.
ATTENTION I$ CALLED TO THE FOLLOWING: -
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside .property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in.street area. Do not cover any portion of sewer before it has beenAnspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.10.030 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 ys will be permitted. -
NOTE No. 4—Trenches in street must be water .settled and 'surface of street restored to original condition. Contractors shalt be -responsible for
failure due to Improper work which may develop within one year of completion.
NOTE No. 5—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 appur-
tenances except to Insert the pipe into the wye.
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