1512 9TH AVE N1111111111111114795
1512 9TH AVE N
APPLICATION
E:ATMiE!PLANT
*-! V
FILE
The Chyof,ldmonds
for [T:R
KEE' swim gxwm P=mT EASEMENT No .................. ............
NEW CONSTRUCTION 0 REPAIRS 0
7'
owNER... u.4e� -------- .............................
ADDRESS --------------------- T../& ...... 4 .. Vic ..... y ...........
CONTRACTOR ------ ------ <0-Al._ --- 7� PERMIT NO
LEGAL DESCRIPTION: L1O,T No . -....... 5............................a..... BIXK.W No . .................... .......................
NAME OF ADDrrION.-4jdA7/V .............sl:�A.A.A.......E..TA47
APPLICATION
for
The Cityof Edmonds SIDE SEWER PERMIT
EASEMENT No . ................ . ........................
NEW CONSTRUCTION j REPAIRS 0
Paul Fritz
OWNER... ...................... I .............................................. C014TRACTOR .......................... ....................................... ...................... ......... PEI:MT No.......... .............
-Bo 95
ADDRESS P.O. X pnwood, Washington .............. Lot 5
RESS ........... ......... ............... ................................... LEGAL DESCRIPTION: LOT No . ...... .................... ............... BLOCK No . .................. * ........................
Northstream Estates
NAMEOF ADDITION .......................................................................... .................................................................
*^Nr-T^•-rgvr�m'^' „"'cR ,fr .' - t x ""M,i;;� of - wi 'l�{•«..`F:r`_a, $'_" -'.^;:r� rt s+:"Z -+'i'' ->s '}• 3.�
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( � i �w CITY O�F +E-DN!DS�`�' ' (S�I!DE, SEWER,0� PER=MIT'-
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WW. AMSEWEK DEPARTMENT � <
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` PERMIT" s
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x�call 776.1107j for side sewer' ,inspectionsr IiEI OREI covering any portion of the: construction l
Inspeci!, n ill> -be provtdcd within 24_hours after "reryuest; rA0 fat.;,- Sun ;: or holiday .inspections
l�ADDRESSaLOCATION:OFCONSTRUCTION`_ ib'E�61;{l!iil
PROPERTY LEGAL' DESCRIPTION i'$ r��`+t ' li S �l't d[,1 ��
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. _ OWNER t1ND/OR:BUILDER : YYCli �{�� C
a - 1 rt r C7 }. ( /t ni ..................................
Y
CONTRACTOR'S%NAME R t1DDRESS:. # t 1CkCi�s 3t VI-a-1 t of S CrEd t l r'ri 4r 1 # ia� (. Ri�cl , L, ll %n60d 9 bit 1
�ertilisgiomis granted 5:.: .....ti .. ..... .... ;;19 ! . ;;for repair andyor connection. of aside sewer to tlio city"sanitary sew.
syst44 in(;aecordance with City'of Edmonds ordinances
-'ATTENTION IS CkLLE,D'TO•THE-'FOLLOWING
r;-,-,,NOTEjNic=•I Theiowners;-of:.,ihe:prbperty.:may:,,obtain°a_,permit-to=consGuct sewer::inside•:property-lino.l k,licensed Side�sewer`Contractor'miist be;einployeditbiconstri
' Ade.'sewer in -strict ,area: ,Do' not cover: any., port ion.of•scwve ' before it_ has,�been* inspected:''::
F ho.;=2- All• work .. J _ - _
performed In cliy rlgni•of way.requires'abi.Invaslon -o(Right-oP-WayPermit;obtainablefro rri Lhe:City. Engineer a/office
y' E"Nofr3 Obtain:aull infofmation�rega.rding,.Ordinancc::I1 1'6:030-and-,Regulations governini side-.sewers<wh.cm:you'get permit.;'
.NOTE rNc 4 Top�of;'sidersewer must- iave;at least" 30 inches:.coverage :at property line- a:nd� 12 ineYies,inside property`Ilne :minimum grade'-oE ~'No •bend'sFdn••gra
`? - ;s ,sharper than: will. be -permitted:.
;r t _NOTE.vNo'„5—Trenches in'street must:be:water-settledsand •surface of street,' restored to' original condiiion ,' Contractors -shall' - be'responsible;-for failure due ,to, lin" o]
work.+whicW.,rnay. develop within one-year of completlon - - - - ,
NOTI.7 No-.6-I[_,is:,unlawtul:to alter•or do.any other•work than is provided for in.the permit; or to do any-,worlc on the main -sewer or its• appurtenances except-te":
sert-the' pipe' mto.the-ivye. - _
DISAPPROVED I f�'Ili
. Dat y Dat� y j D to By
APPROVED Q}� Dae\''_ .......• a 'ZBY
/ ` GJ�/
Renia rlis': ..
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'BUTH,`Pe}nlit';Copies MUST Be Signed By Ownef of Flrm Performing Construction PRIOR To. -.Request, Inspection, —
I(:, aGZt.YJ ,•.�,�{J.. / F helebv certify that the side sewer installation constructed under,th�sperlii
(Owner' of`ContractingiFirm .PerCcrming; Construction)
was Installed ilr;accordance withal goyerrurig.'ordlnances of the Clty of Edmonds
his da,y,of j,,..
Dated- t• t�,_;j ��
19r
J J Check BEFORE. you dig for Water � i. Geis ❑ Telephono ❑ Power s Sewer 0 Other,❑ '. ',� �b
\c_..b._a,. .-_......tea..... ... _..�.,__.�..+.�._�-_ _. .__..-. .. .. .-r..._.. �._...., '1•w.. �. _..._. ..,. .. _.._ �.. _._... ..._.._.. n.-.x........... .... ._._.._ .�.-.._. .>_....._....c.. ,. r,9 .. `�
OME City of Edmonds
ET F6LE a y
'y RIGHT-OF=WAY CONSTRUCTION
-�` PERMIT 5J
Permit Number:
Ili
4 Issue Date: b �0
A. Address or Vicinity of Construction: 1512 9 Avenue North
j 8 �.O B. Type of Work (be specific): Install New. Service
C. ContractorWash Nat' 1 Gas Compafly Contact: Frank Swan
Mailing Address: 815 Mercer St.: Seattle, Wn Phone: 224-2278
State License #: 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
'❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:%
F. Pavement or Concrete Cut : )0 Yes []No (2) G. Size of Cut: , 2 x 4 H. Charge $
@ gas & water
APPLICANT TO READ AND*SIGN
INDEMNITY: Applicant understands and by his signature to this application; agrees to hold the City of Edmonds harmless from injures, da ages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be 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 including defense costs, and attorney fees by reason of granting this permit.
THE CONTRA CTOR IS. RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLO WING THE FINAL INSPECI70N
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH. IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSEDAFOR' SUJNCE TO THE APPLICAA%
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. k
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engi eer.
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 understa �""
r�,a the pink copy of the permit will be available
on site at all times for inspection .purposes. �'�
Signature: Date: July 27, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
..
FOR CITY USE ONLY
APPROVED BY'r YY>RIGHT OF;WAY:DEPOSTr:
: TIME AUTHORIZED: VOID:AFPER ::O." DAYS DISRUPTION; FEE/FUND 111 >
i,.SPECIAL. CONDITIONS: A RESTORATION FEE .:
PERMTr. FEE:: -
COMMENTS: "�� Moo RECEIPT NO:.
DATE: = ISSUED BY
II"
Engrg Div. 1991
t
FIELD INSPECTION NOTES
(Fund III - Route copy to Street Dipt.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved. By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
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Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by:
Engineering Aide
Washington Natural Gas
622-6767 X2761
pager a►�r9- I�p
• ���- x�J � ohs
-w- water
-g- gas
-ss- sewer
vater hydrant
8L Maser SL (P.O. Ban 1369). Seale, WA 98111 =6) 6=-676
'� W'F�-u�.isv.�Klh'i y«Y,tb; y��n�-:..- r-�1u •: {`�"• t_.J.�.«..r.�.Ft-„«y.,;"^��ti.a'�'iu .,• e.; •Y � ,,,�;.:�...'fr..."'u" �. .. :��r�� 5.• ":1:c ��,..-..,u.-.^r:.,.a�.,��
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City
of Edmonds s
IIT-OF-WAY CONSTRUCTION
890_199-
Permit Number: /
Issue Date: A9 9oZ
A. Address or Vicinity of Construction: 1512 9 Avenue North
B. Type of Work (be specific): Install New Service
WAIVE PERMIT FEE PER ROY WRITCUTT
Gv PERMIT
C. Contractor: Wash. Nat'l. Gas Company
Mailing Address: 815 Mercer St. Seattle,Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project N Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: o)
F. Pavement or Concrete Cut : RiYes []No G. Size of Cut:—, 2 x 4 H. Charge $
APPLICANT TO READ , ND SIGN @gas &water
INDEMNITY. Applicant understands and by his signature to this application, agr to hold the City of Edmonds ha"rn�leseftotfl in ones, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any,yf its depnts or employ-
ees, including or not limited to the defense of any legal proceedings including defense coslrs'and attorney fees by reason ofgra/itlpg t is ennit.
A
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ON FEES WILL BE I fEy_UN77L THE FINAL S7REET PA CH JS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUAl1CCE"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
Work is to be inspected during progress and at completion. �71�022®
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 times for inspection p es.
Signature: Date: October 8, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
ONLY
BY..:::: �W.:: :: RIGHT OF -WAY. DEPOSIT:
iORIZED, ,VOID AFTER" 2 DAYS. ._.. DISRUPTION: FEEIFUND 1,1 I:..
RESTORATION FEE:
.....PERMIT FEE:..
-TOT
.........
..._ DATE
......
ISSUED BY;.;. ri �/ elu l-E{ -w w f
7
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.NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE'
Engrg.,D�1vr 1991
FIELD INSPECTION NOTES (Fund I I - Route copy to Street Dept.)
Comments:
Diagram•
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work, Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1'
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,k City of Edmond
RIGHT-OF-WAY CONSTR CTION
.J ^ PERMIT Permit Number: - S
Issue Date•
A. Address or Vicinity of Construction: 1512 9 Avenue North
8 9 p Q. B. Type of Work (be specific): Install New Service
1 9
C. Contractoryash. Nat'l. Gas Company Contact: Frank Swan
Mailing Address: 815 Hercer St. Seattle, Nn Phone: 224-2278
State License #: 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:%
F. Pavement or Concrete Cut : M Yes ❑No (2) G. Size of Cut: 2 x 4 H. Charge $
APPLICANT TO READ AND SIGN @gas 6 water..
INDEMNITY. Applicant understands and by his signature to this application, agrees tb hold the City of Edmonds harmless from injithes, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be 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 including defense costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING TILE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ONFEES WILL BE HELD UN77L 7HE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED'FOR ISSU4NCE 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 understa permit reapdrements and the pink copy of the permit will be available
on site at all times for inspection purpos /-Ae
Signature:
Date: July 27, 1992.
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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EDMONDS
PUBLIC WORKS ENGINEERING
ACTION REPORT
N? 2659
SUSPENSE DATE:
Date: Time: —!� 3 File #
Attachments: =Yes
SUBJECT: =No
REQUESTOR: NAME:
ADDRESS -
PHONE:
Ll 02 1 .41 NZ,f
REQUEST RECEIVED BY:
z
TELEPHONE
CONTACT IN OFFICE
OTHER:
RECEIVED By..
RNITP Tn.
t..jjz.\" J= N I ' If, 1 P4 C 3 K NInT I F1 Ef')
_j
All Concerned Notified
Action Completed/File