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'! City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
n t lt d I - I L ERMIT Peat Number.
/ S Issue Dater "3
A. Address or Vicinity of Construction:
B. Type of Work (be specific): Inst. 2" E IP Main in 9 Av. S. from 26PEN
Sery cto es to 320. an 1 Av. S.
C. Contractor: Washington Nat'l Gas Co. Contact: Frank Swan
Mailing Address: 815 Mercer St.Seatt Phone: 224-2278
State License #: 9811 Liability Insurance: Bond: $
D. Building Permit # (if applicable): _
Side Sewer Permit # (if applicable): .
E. ❑ Commercial ❑ Subdivision ❑ City Project 0( Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 13 Yes ❑No G. Size of Cut: (6 2 x 4 H. Charge
APPLICANT TO READ AND41GN
INDEMNITY: Applicant understands and by his signature to this application, agrees to W41d he City of Edmonds arm a jrgm-'nj damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be d gainst the City of Edmon� .o" a £ it artments or
employees, including or not limited to the defense of any legal proceedings including defensAcosts, and attorney fees by /reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR 14 PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMA TED
RA
WILL BE HE
IS COMPLETED BYCITYFORCES, AT WHICH IMEA DEBIT OR CREDIT WILL OBEP[t GOaS'SED FOR ISSUANCE�O RbIFi�%,&IICANT. ATCH
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. 1'
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 thepink copy of the permit will be
available on site at all times for ins
pgctirn purposes,.
Signature: a `t' °� Date: July 20, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W -'W l• of RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 7-t J -93 DAYS
SPECIAL CONDITIONS: —l- —NIOT Cjr-TT 1k
F S+ 1D IZI Ali' S \.N k N OT 7
COMMENTS:
DATE:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
RECEIPT; FEE:
ISSUED BY:
aP
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Stireet Dept.)
Comments
I Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ P40
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PLEASE INDICATE BELOW IF YOU WISH TO SPEAK ON THE FOLLOWING ITEM:
Item 8 HEARING ON TRAFFIC CONTROL PROPOSALS FOR 9TH AVE. S. BETWEEN
MAIN ST. AND EDMONDS WAY
Name (Please print clearly)
L4 Al
KA.
%! t( ,
Address
K 6 du
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w
/6 /3 Q t_ly q vim' . Sc-o- .
k APPLICATION t �T�`" •_
i CARD No:
for
The:Cit _O; dmOndS SIDE SEWER PERMIT
EASEMENT No. ---------------------------------
OUTSIDE ❑ _ . _ INSIDE ❑ REPAIRS
R1i6ii�II�'iiR�l®IIM Affi MA7s �f � _ •
OWNP.'I't ...- .... f1 = : /../GI!c/.' _--..... -----•-•• ---•- --••----- -•--..... CONTRACTORS ;JC`/Y .............. PERMIT No.`_. ` 5..�
G ` �?:S C I :fi- •:'- STREET ;
HOUSE No. _-I �j.�-----------I- �a�. `J. -------------------- AVENUE LOT No_ _----••---------•------------•---------------- ............ BLOCK No. ----------------------------------------
a•- -- ------• •--
NAME ADD. _._..... ;
��
--•.................•------ ----. .
Date Approved:
QACKFILL WORK ORDER ISSUED __________________________________ DEPOSIT, $ .............................................
` sEwER WORK ORDER ISSUED ........................................... DAiE/_........_.__. y ,•..aI `...�.... -
/ _•• -- / _
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CITY ® E0 M ® N. ®s;
PIJ'C3yL14 F�Vj � GCS DEPARTMENT
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SUSPENSE DATE:
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TO:
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Z
Q
DIRECTOR
Investigater�
and Report
ADMINISTRATIVE SECRETARY
Take Appropriate
6BUILDING MAINT. FOREMAN
Action
Prepare
letter/memo
EQUIPMENT RENTAL FOREMAN
PARK DEPARTMENT SUPT.
for my sign.
For Information
Previously Ref 'd
Status of Action? -- X
STREET DEPARTMENT SUPT.
TREATMENT PLANT SUPT.
;WATER/SEWER SUPT.
Return to:
COMMENTS:
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FROM: 10'
DATE: Z�:)
CITY O.F E D M 0 N D S
PUBLIC.WORSS 2 ENG1=1N6 .
-FILE:
ACTION REPORT
SUSPENSE DATE: •'
Date: _ 11/24/82 . - Time: 1: 15 pm File # .
Attachments.: DYes
SUa,iECT: Hearing,;very Istrange noise_ in her >d3MNo
pipes. Could' someone.please"give_her a call: so,
she'can. explain it. -She., is. at work,will..,not-, be
home ..until after. 4:00 p•.m.; You can cail her.at,
work,.
REQUESTOR: NAME. -:Mrs. Wallace
^1`O13Ave..So I
ADDRESS:_
PHONE, 527-3412' unti1`:4 OO�p.m; ,
REQUEST -RECEIVED BY
.. .. ' TELEPHGNE- .. ..
CONTACT,IN OFFICE cC '
RECEIVED B'Y. M. v Lean
i
ROUTE TO:
#
OPR
NAME
INIT.
DATE'
#
OPR-
NAME
INIT.
DATE:
i
L.. Willeiksen
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Joi3 Cjo. P.456
APRIL 13, .11363
S ,,HCET I OF
DESCROPTIONS FOR: PC E WEE INVESTMEN
PARCEL A
ALL THA'1' eowric):4 Or 'rI,IE SW4 OF THE NEj4 OF SECTION 25� T21114,_ P3E, w.m,,
AT THE SOUTHWEST CORNER OF 1,541P, SU1.3[',ILVI310.^4;
THZNCE S ALO!AG THE *SOUTH LINE OF SAID SUBDI VI$1,)N, 30:00 FE:r-f;, -nir-NcE
ij.0 0 jo, A PA L L L '—VIM, VIC WEST LINE Of SAID $U801 VISIOr4, 1078.B2 FEET TO THE
TRUE P61'4T OF OF THE TRACT Of LAND HEREI,,4A)E3cRIoE1r),' THEN . ICE, CU!4T I f4U I t4 C�
N 0o3(-`1 17
Lj 146.52 rEFT; Tfir-'4cc 5 0031'15"W 82,96-
FEET; TriC N 0J)2 s FL -ET TO Tv!c TRUE POINT OF
SiRW E CT TO r-4 K'A5EMENT FOR 14GRCSS AND EGRESS AND FOR UTILITIES OVER,
UNDER A\I) UP01 THE SOUTH 10.00 FEET THEREOF.,
SI T UIA T I K' f) I rI S110 i 10M I SH ('01PITY, WASHIN?�TON,
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CITY
, , v *— work
0"7 *Aii"X;W-M DEPAR
N 806
F SEENNEW P,
.......... ............. .................... . ...................... ...............................
1013 Ninth A t
.......................... ........
R ows H"
Ken Hovda
..... I ....................................... T" .. ....... ............ ...................... ..... .....................
Pormlsolon Is granted ...... Agatt'.A9 ...... : .......... 19;4 for ...... or CONNECT 4 side sewer
i4lih dti'Sewers-in 'socordaimoe with appUestion on file and governisig orft"oeg.
ATTENTIONIS CALLED TO THE FOLLOWING:
NOTE Nb. I —The owners of the property may obtain a permit to construct "war Inside property line. A licensed Side Sower Contractor must
be employed to construct aid# sewer In street area. Do not cover any portion of sewer before It has been inspected,
NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 , and Regulations governing ads *aware when you get permit.
E NO f side sewer must have at least 30 Inches coverage atproperty line and 12 inches inside property line; minimum grade of 2%.
No.
bends in grade sharper than % will be permitted.
nds
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion,
Y No. 1�--It to unlawful to alter or do any other work than In provided for In the pamit, or to do any work on the main sewer or its ap-
purtenances except to insert the pipe into the wye,
A
31:j O
Tic^ d O
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NO
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DFSCR;c'TiGN
REVISIONS
DATE i BY
MOTES: EDMONDS
1.) FIELD LOCATE ALL, UTILITIES
CALL 1-800-424.5555
48 HOURS BEFORE DIGGING
2.) LAY, DETECT WARNING WIRE OVER
ALL PE DIRECT BURIAL PIPE
3 .) . . INSTALL A ONE POUND ANODE —FOR
EVERY 1000' OF LOCATING WIRE '
4.)- SURVEY IS NOT REQUIRED
5.) MAINTAIN,A MINIMUM OF 5'
HORIZONTAL AND A'3' VERTICAL
CLEARANCE FROM ALL CITY -
UTILITIES AND APPURTENANCES
6 .) C AV I ARE SHOWN AS
.) CUTS TICIPATED
,n —
E -
7 -
TEVI OUAN-T DESCRiPTiOld SOCK NO
BILL OF MATERIAL
PERMITS 114 SEC
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lI atur5N Gas �® .Grp NO
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DRAWING
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D h DO RECEIVED
CLAIM FOR DAMAGES :: r MAY 2 71 g75
NOTICE '
CITY OF MON.
Claim MUST be presented to. the City Council arid. filed withatthe..,Cy.- er 20 days ar,
GI CLERK
from the date of Accident.or Accrual of ,Damages,.:
TO THE CITY COUNCIL OF THE CITY OF EDMONDS:"
PLEASE TAKE NOTICE THAT cn.,
(if married, give husband's name)
WHO NOW RESIDES AT ' / n /.,3 � 1 S> . >S
(State present actual address by street, number and city
AND 17HO FOR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT
Give residence by street, number and city
,act
CLAIMS DAMAGES OF AND FROM THE CITY OF EDMONDS IN THE SUM OF %�;•
arising out of the following circumstances:
Describe Claim, giving
DATE and TIME injury or
damage occurred, PLACE
and full particulars.
Accurately locate and
describe defects caus-
ing injury or damage
and all acts of negli-
gence claimed.
Ia S D L(e rf/ 3g�; n ti/ 0-7 lac n Z,_7 r r- /%
Accurately describe
injuries or damage
_43 i1:�1e1Z.l1/cr1s y
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.SA�y�, yiil=i c"/ /=til'C iE�
State items of damage
C). _
claimed. Itemize all
f
``
expenses and losses.
i3e- ,'.� /�, f�, e,?
(Claim must be sworn to by claimant)
4J " 'l4 T/L7�'
Signa ur.e--of Clai ant
SUBSCRIBED AND SWORN TO 04
before me this ,2 O day of 1 ,19
Notary Public in and fbr e to oJ.
Washington, residing at