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8300 214TH PL SW
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.��'-' ► o
Issue Date:
A. Address or Vicinity of Construction: 8.300 214 PL SW
18 B. Type of Work (be specific): INSERT 1-1 /4" PLASTIC GAS MAIN FROM 30' E TO
9 p-19 435'E C/L 84 AV W IN 214 PL SW. SEE ATTACHED DWG 9709342. '
C. Contractor: PUGET SOUND ENERGY Contact: TOM LING / DANIEL CHAN
Mailing Address: 1122 75 ST SW, EVERETT Phone: 356-7530
State License ti: 98203 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: RVJ
F. Pavement or Concrete Cut: ® Yes ❑No G. Size of Cut: 2.x 4 H. Charge $
—+ J.
APPLICANT TO READ AND SIGN , f
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 unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings 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 THE FINAL
INSPECTION AND ACCEPTANCE,OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH r
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
W
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 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 th.e permit will•be
available l at all time. o inspection purposes. G
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FORCITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER — UVLY 1457T DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: _WA RESTORATION FEE:
PERMIT FEE:,
D y� TOTAL FEE:`
COMMENTS: 1 ('� • RECEIPT FEE:
��
ISSUED BY:
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 ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
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NOTES
1. NOTIFY ONE CALL 48 HOURS PR10R TO DIGGING AT
1-800-424-5555.
2. NOTIFY TOM LING A7' (206) 356-7530 PRIOR TO ANY CHANGES.
3. NOTIFY CITY OF El DMONDS INSPECTOR 24 HOURS PRIOR TO
CONSTRUCTION AT 206 771-0220.
4. P_l#_ff_#1 DENOTES EXISTING ACTIVE SERVICE.
5. TEST & TIE -OVER EXISTING ACTIVE SER VICES 7'O NETIT M,4IN.
6. REPLACE EXISTING ACTI VE STEEL SER VICE WITH 5/8 "
PLASTIC SER VICE.
7. RETIRE ALL INACTIVE STUBS
LEGENDS
0 EXISTING CATCH BASIN
EXISTING SEYVER MANHOLE
O EXISTING POUTER POLE
No.
DESCRIPTION
I DATE
BY
APP'D
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
E
TEST
INSTALLATION / RETIREMENT
SUMMARY
TYPE OF TEST:
PRESSURE:
L
DATE ON:
TIME ON:
I / R
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
—
TESTED BY:
weo®sarwr
Gm
A`wCO�Ofj
OP MAP: /6¢-o69
PLAT MAP:Natmr,A
i/4 SEC: NE 30--27-¢
WORKAREA:
PROPOSED
MAIN
FOOTAGE
EMERGENCY SEC. No.:
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: Psn
D
#0 ••
PE Ivp
_il/o
SYSTEM MAOP: Pstc
Psn
E
PERMITS:
s
G
N
//G /V
9300 "j 21V SAI
DRAWN: KTSAbh�-
¢`27,-97
JOB No. g709347-Z
CHECKED: �-�
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RAWING NO. ��o�� / I /
APPROVED:
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NOTES
I. NOTIFI' ONE CALL 48 HOURS PRIOR TO DIGGING AT
1-800-424-5555.
2. NOTIFY TOM LING AT 206 356-7530 PRIOR TO ANI' CHANGES.
3. NOTIFI' CITY OF EDAIONDS INSPECTOR 24 ILO URS PRIOR TO
CONSTRUCT ION AT (206) 771-0220.
4. # # ## # DENOTES EXISTING ACTIVE SER 1jICE.
5. TEST & TIE -OVER EXISTING ACTT VE SERVICES TO NEAT MAIN.
6. REPLACE EXISTING ACTT VT STEEL. SLR VICE II17771-15/8 "
PLASTIC SER VICE.
7. RETIRE ALL INACTIVE STUBS
LEGENDS
EXISTING CATCII BASIN
EXISTING SE, 6VER MANHOLE
O p� EXISTING POiI,ER POLE
No.
DESCRIPTION
DATE
BY
APP'D
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
I
E
TEST
INSTALLATION I RETIREMENT
SUMMARY
TYPE OF TEST:
PRESSURE:
L
DATE ON:
TIME ON:
I I R
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
TESTED BY:
AV on&-fvyCbrnpery
OP MAP: . /6¢ -o6 8
�-069
PLAT MAP. /6ik
114 SEC: 'vEC.
WORK AREA.
PROPOSED
MAIN FOOTAGE
EMERGENCY SEC. No.:
MAIN SRE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: PSro
D
/4 I �
PE �p
¢/0
SYSTEM MAOP: PsIG
Psn
E
PERMITS:
.s
N
9300 Aj 214 AI
DRAWN: KrsAN�
¢-27--97
JOB No, 97093-5Z2
CHECKED: -''�
�' Z3
RAWING NO.
970F.34,7 / /
APPROVED:
Z3
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NOTES
1. NOTIFY ONE CALL, 48 HOURS PRIOR TO DIGGING AT
1-800-424-5555.
2. NOTIFY TOM LING A7' (206) 356-7530 PRIOR TO ANY CHANGES.
3. NOT IF)' CITY OF EDMONDS INSPECTOR 24 IIO URS PRIOR TO
CONSTRUCT ION AT (206) 771-0220.
4. F f-fl-TRI DENOTES EXISTING ACTIVE SERVICE.
5. TEST & TIE -OVER EXItSTING AC77VE SERVICES TO NEW MAIN.
6. REPLACE EXISTING ACTIijE STEEL SERVICE WITH 5/8"
PLASTIC SERVICE.
7. RETIRE ALL INACTIVE STUBS.
.LEGENDS
o EXISTING CATCII BASIN
EXISTING SEWER MANHOLE
O EXISTING POWER POLE
No.
DESCRIPTION
DATE
BY
APP'D
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR: COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
E
TEST
INSTALLATION / RETIREMENT
SUMMARY
TYPE OF TEST:
PRESSURE:
L
DATE ON:
TIME ON:
I / R
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
TESTED BY:
A1hl�tha>Q4onErxxvYCo�TPm*�
OP MAP:
PLAT MAP:
114 SEC: NE
WORKAREA
PROPOSED MAIN FOOTAGE
EMERGENCY SEC. No.:
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: PSIG
D
//¢
410
SYSTEM MAOP: PSIc
PSIc
E
PERMITS:
s
G
N
/ f�'f'E" /rP HA/X,/ IllSe"!,7"
g300 AJ 214 R/ SAI
DRAWN: KTSi1N�
¢'Z? `!7
JOB No. 97093,�r-2
CHECKED: /'^'�
23
RAWING NO.
APPROVED.
23