10511 243RD PL SW.PDFiiiiiiiiiiii
4659
10511 243RD PL SW
ADDRESS: 0511 r ZG131,67l PL k-)
TAX ACCOUNT/PARCEL NUMBER: , �`0�—f — OD�'�''(/��, m
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS(RECORDED)FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA'
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMITS) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER MET'nER' TAP CARD DATED:
OTHER:/�
LID #:
LOT: BLOCK:
LATEMP\DSTs\Forms\Street File Checklist.doc
City of E,dmonds Permit No• c
RIGHT—OF—WAY'CONSTRUCTION PERMIT Issue Date: 7g2/-0)
1 � -
A. Address or Vicinity of Construction: 10511 9ty_'A PT. qW
B. Type of Work (be specific): P$"ISSION IS REQUESTED TO INSTALL A 2" PLASTIC MAIN TIE IN FROM t16'N
C/L OF 243 PL SW AN;b t153" E C/L OF 106 PL'W, CONTINUE EAST TO THE END OF MAIN
t124'E C/L 105 AV W TO SERVE TARGET 1051-1 105 AV W
PER JOB : #107OnQ64h
C. Contractor: PUGET SOUND
Mailing Address: 1122 75th S� SW
State License #:
D. Building Permit # (if applicable)
Contact:- DOUG USITALO
Phone: 425-356-7520
Liability Insurance: Bond:
Side Sewer Permit # (if applicable): I r F a
E. ❑ Commercial t�Da 3" di ision �,L ❑, City Ppject ❑ EUC (PUD,�GTF&� PS§F1, CIIAAMBERS, OVWD)
❑ Multi -Family ® Single Family ❑ Other
INSPECTOR•
F. PAVEMENT: ❑ YES :] NO G. SIZE OF CUT X H. Charge: $
CONCRETE CUT: ❑ YES] NO r*
APPLICANTTO READ AND SIGN
IDEMNITY: Applicant understands by his/her signature to this application he/she holds 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 but not limited to the defense of any legal proceedings including de/ensq-co-sts and
attorney fees by reason ofgranting this permit. V:
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 IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger +'must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
♦ Three sets of construction drawings of proposed work are required with the permit application.
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND'ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature: .
J�C ` Date:
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
� 1 -
( FOR CITY USE ONLY
A P ,owed by 4 i Yi� 1\ Right-of-way Fee: n 0 �"� + S7
Tima Authorize Void Ater Disruption Fee/Fund 111:
�S .ecial Conditions; Restoration Fee:
�
Total Fee:
Receipt No: r`
d Issuediby:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK:
INSPECTOR'S SIGNATURE DATE: i1 v Z
For inspection requirements see Engineering Information Handout.
PUGET
SOUND
ENERGY
10511 - 243 PL SW
Order # 107009640
Date: 9/08/2000
ROAD
TRUCTI
AHEAD
GNE LANE
AHEAD
sE
aREVAREo
TO sTDP
T
200 FT
200 FT
200 FT
200 FT
100 FT
I
iffil
A 44AFFIC CONTROL PLAN
City of Edmond
:a: 3 vA*MMAV:
3
V)
J
PM
Q
N
Submitted by:
Juliano Nguyen
Engineering Planner
425-290-7026
TABLE A
SPEET
(MPH)
TAPER LENGTH
(FT)
CONE SPACING
ALONG TAPER
(FT)
OFFSET WIDTH
10'
1 12'
25
105
125
1 25
30
150
180
30
35
205
245
35
40
270
320
40
45
450
540
45
NOTE:
1. FLASHING BEACON SHALL BE
INSTALLED AT EACH SIGN FOR
NIGHT-TIME USE.
2. DISTANCES MAY VARY AS APPROVED
BY THE ENGINEER.
3. FLAGGERS REQUIRED TO CONTROL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC FLOW.
4. SIGN SIZE PER MUTCD.
LEGEND:
® (SEE OR CHAOZNELIZING DEVICE
WORK AREA
TRUCK N TTH
FWJ_ FLASH IN UR WITH
BEACON <s>
® I
® 125 FT
105 AV W I
l
I 200 FT
0
---- - - - - - - - 200 FT
o PREPARED
TD srOP
{
200 FT
0 0 0 0
o ONE LANE
AHR M
LL LL �- LL LL 200 FT
i
N N N N O
O
3{ ROAD
p <9>
'ugci SOI:f{d `il„Iqy, l i - • 1 ;'2 - 7o;; `:i.. `).' ! _`••bf?il {ifs. �_ ..
4
N
0
a 501
1
d 0'
d
X
EX. 2" PE 1 P 1 6'N
3 912-010
PINGH 4� FUSE
153'E C, 1$ 16'N
EOM
<-- W --wl W W --s
Lo
O
610 '
� r '
ENO MAIN
I24'E L
--13` — — —
GAS
MAIN INSTALLATION RETIREMENT
TYPE
MANUFACTURER
28'
MP6
FUlMSIZELENGTH
GAS MAIN PRESSURE
& TESTING
TYPE
TEST:
PRESSURE:
TESTED BY:
DATE
ON:
/ /
TIME ON:
DATE OFF: / /
TIME OFF:
DATE
ON:
/ /
TIME ON:
•:
DATE OFF_: / /
TIME OFF:
DESIGN:
PSI_G
SYS MAOP:
PSIG
NOTES: The City of Edmonds
1 . F 10,0 I.OGATB AI.1, UT I I. I T 166)
GALA, 24 HOURS WORE DIGGING+ 1-600-424-5555
2. SURVEY 16 NOT REOUIR60.
3. MA i NTA I N A M 1 N I MUM OF 5' HOR I ZONTAI, ANO 3' VERT I GAI.-
GI.EARANG6 )%ROM AW, GITY UTILIT1E6 ANO APPURTENANGE6.
4. GUT6 IN PAVING ARE 6HOWN A6
5. Q_ 6UT6 IN PAVING ANTIGIPATEO.
6. PROJECT MANAGER, 000G U61TAIO 425-356-7520
ill
_I
CALL 1-800-424-55-55
2 BUSINESS DAYS BEFORE YOU DIG
on irn "Dnni rnp rvnrT InrATTnm nF FACILITIES
5
/ /
REAL ESTATE/EASEMENT
PERMIT
60MON06
4
/ /
3
/ /
FUNCTION
CONTACT
PHONE NO
DATE
2
/ /
PROJECT MGR:
0. U61 t 1.0
(425) 356 -7520
09/0ey 0
1
/ /
APPROVED BY:
(1. )'DIY
REV#
DATE
BY
DESCRIPTION
ENGR - GAS:
COUNTY
SNOHOM 1611
MER SEC
Work Center
N6NHG
DRAWN BY:
J. N&UY6N
025)290
702609/0
0
REVISED BY:
1/4 SEC
6W — 36 —
27— 3
OP MAP
161. 062
PLAT MAP
1 67. 066
APPROVED BY:
FOREMEN #1 :
U-MAP# (POWER)
CIR MAP#
CIRCUIT#
FOREMAN #2:
MAPPING:
JOINT FACILITIES ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
24 MPE IF MAIN OXTON51 ON
PUGET f0 66KV61
SOUND
ENERGY 10511 - 243 P1, 5W
T
INCIDENT#
DRAWING#
SAP
10700964a
SUPERIOR ORDER#
SCALE: 1 " =
50 ' 1 /�` 1