21400 76TH AVE WIIIIIIIIIIIIII
15188
21400 76TH AVE W
C�.
890 99
City 01f-:Edm. onds
(MGHT-OF- "CONSTRUCTION
PERMIT Permit Number.
Wue Date: /Z
A. Address or Vicinity of Construction: 21400 76th AV W
B. Type of Work (be specific): Spt 45' polp 70'snut nf pole stAnriled
-U-2QQ. Remove pele Gc 290-M. -1 a Ae-
r_1 O.S for a pHi_4_fir�-- y
Contractor: -Snohomish (niinty P11D No I Uo Matt Merpynelds—
Mailing Address:PQ BOX 1107 Everett, Wa gko6ftone: �147-4414_-/ q14-5697
State License #: Liability Insurance: Bond: $
D. Building Permit # (if �pplicable):
Side Sewer Permit # (if applicable):
E. Commercial E] Subdivision City Project Utility (PUD, GTE, WNG, CAB LE, WATER)
Multi -Family 0 Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes 1]No G. Size of Cut: /X H. Chargq_$
APPLICANT TO - READ ANA, GN
16Y 0�(�p
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINA L STREET PATCH
IS COMPLETED B Y CIT Y FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE A, PPLICANT.
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 beinspected during progress and at completion.
Restoration is to be in accordance with City C6des.
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 iiiaterial prior to the end of the working day;
N6EXCEPTIONS.
Ihave read the above statements and understand the permit requirements and thepink copy of thepermit will be
available on siat all times or insp o_4�poMoses.
p
. toi;f
Signatur - - Z-11, Date:Octoher 98, 1996
Contractor 2f�qent)
/CO
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED :VOIDAFTER J.h,i DAYS
SPECIAL CONDITIO I NS: A-T
L.A IQ C-% (.�Qn
COMMENTS:,
DATE:
go
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1991
FIELD INSPECTION NOTES
Comments:
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:
ISN�l� COUNT9
13�> OLD M
Fw-x—u,,u"--fwj, PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY SBSEED.DCN
LOCATION— 21400 76TH AV W SO COUNTY AREA'
POLE NO./PLS GC-299 NE1/4 SEC30 T27N R4E DATE 10/23/96 W.O. No. 29004A
REASON FOR WORK RELOCATE POLE GC-299 TO ENGINEER MATT. MCREYNOLDSDWG. NO. 117777
ACCOMMODATE NEW WOODWAY HIGH DRAFTER U.C. NO. —N/A
SCHOOL CONSTRUCTION. SCALE 1" = 100,
DATE WORK COMPLETED
FOREMAN APPROVED DATE PRINTED
ENVIRONMENTAL ANALYSIS
NEXEMPT 0 NOT EXEMPT
FEES REQ'D IX YES 0 NO PARA. 18 ITEM C— SUBSTATION FIVE CORNERS
�RIMARY OVERHEAD "'Q� U. G C 0 N D. KV CIRCUIT NO. 12-1284 PHASE 1,2,3
'M Y 0' H. U.G. COND.
0 0 R=IDENTI�AL CKT.FT. PH
OMM rl
OMMERCIAL
LEO NCl._ REM CKT. FT. PH
NET CKT FT
'@s — I=$
SECO OVERHEAD
BASIC FEE S
La S
METER/COI�V. POLE
PRIMARY U�DERGROUND
0 RESIDENTIAL �SIC FEE S
0 COMMERCIAL
O.H. U.C. XN - D.
KV
ADD
CKT. FT. PH
REM
F T. PH
NET
�KT.
C . FT.
PERMITS
(DAT COMPLETE)
0 TREE TRIM
0 STATE
0 COUNTY
IX CITY
CVT(ZTIKlrl
LEU NO.
If ONSTRUCTION PERM"IT
EASEMENTS
M REQUIRED 0 NOT REQUIRED
SECONDARY UNDE GROUND
BASIC EE s
UNDERGROUND PLAT
DATE RELEASED
BASIC FEEI
—q- FTAag
FOREIGN CONTRACTS
0 GTNW JPN NO.
STREET LIGHTING
q FT.@$ =s
MCATV JPN NO.
0 JOINT TRENCH GTNW & CATV
0 JOINT BORE GTNW & CATV
WORK IN RIGHT OF WAY
0 PRIMARY
0
c
POLE STENCILING
LFRem
0 SECONDARY
F T. @ S
To GC-299
TAKE OFF POLE
MISCELLANEOUS FEES
VAULT 3
PRE-CONST. REQUIRMENTS
PERMIT 3 30.00
0 TREE TRIM 0 PUD LOCATOR
RELOCATE POLE s22og-nn
0 BACKHOE M FLAGGING
W.ONE CALL DATE 10/23/96
NO. 964 03508
TOTAL DUE s2239.00
INULA
j POLES
I
PLAT
LOGS
DATE PAID
RECEPT No.
XFMR
C-MAP
:A:F,:]
NEW SVCE APPLICATION NO. LOCATION
MAP PAGE 455
LEGEND.
0
EXISTING POLE - NO CMANGE
SET NEW POLE
REMOVE D05TING POLE
ENGR'S TEL.
F514-5627
ENGR'S PAGER #
,F514-9038 SW 12 —349
at G--297
ff �-fflj
L-2204 X 1-79
GC-298
000DWAY
HIGH SCHOOL
1-78
G C - 2 9 9
NEW EASEMENT
c-
I
CC-300
�l 1-77
FU100
.................
�N
m - o
Fb25
2-57
A-23130
18-18-18/02
[2 >
10
----------- L
MOO 215 TH
-----------
i (-0
� F*I- r 2-59
SET AND GROUND 45'POLE AS STAKED 70- SOUTH
OF EXISTING POLE GC-299.
INSTALL ASSEMBLY 12F337, L=12'WEST (X0501 IF NEEDED).
STENCIL POLE GC-299
(D STRIP TOP AND ABANDON POLE TO CHAMBERS CABLE.
ST SW
191v
CHAMBERS CREW TO TRANSFER PER PUD SCHEDULE.
REMOVE PUD GUYS AND ANCHOR.
100 50 0 100
1" = 100' SCALE IN FEET
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