7000 212TH ST SW.PDFiiiiiiiiiiiiii
15921
7000 212TH ST SW
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 7000 212 St SW
18
9p0, B. Type of Work (be specific): Repair Leak
19 '
C. Contractor: Washington Natural Gas Company Contact: Frank Swan i:. I FILE
TR
Mailing Address: 815 Mercer St, Seattle; WA Phone: 224-2278
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project J�J Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : bd Yes L1No G. Size of Cut: 1H. Charge $
APPLICANT TO READ AN GN
\ INDEMNITY: Applicant understands and by his signature to this application, agrees t o the City of Edmonds harmle go. i ages, or,
claims of any kind or description whatsoever, foreseen or unforeseen, that may be m gainst the City of Edmonds, ran of its de tments or
employees, 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 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 IbL� -PA—YE$SED FOR ISSUANCE T? fH�AP fYCANT.
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 Lhe 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 ti or inspection purposes.
Signature: /- ��ww ,� - Date: November 9, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
-FOR—CITY USE ONLY
APPROVED BY: t�t RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER �, ��— DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: TAA FIG. =tArKUL- RESTORATION FEE:
M —"" PERMIT FEE:
3 PM VLL km DT'M PAV t N TOTAL FEE: ,% LJ — 4t
COMMENTS: 'To LV 0'3 X 4 S L F RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.) t
Comments
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
11/09/93 10:22
�lon
N.O.B. WASH. NAT. GAS.
AWWvgo bwWC&TQwv
Addendum to City of Edmonds
Right of Way
Permit Application
_. Submitted by: Guyla Connors _
- ---- Engineering Aide
1 e 9 0 r n- Washington Natural Gas
521-5248
'7oap iZ 57 5cO
WNG to window
Water main depth
unknown
" gas 1nain
L- x GUP.3 To � C IDAT")
Key:
002
-w-
water
..gft,
gas .
-as-
sewer
-Q-
water hydrant
Q
water valve
81; Moma 5t, (P.O. Hoc 1869), Sattlt, WA 98111 (206) 622.6767
CITY OF EDMONDS
01 L►J NEW
❑ ADDITION
❑ RETIREMENT
ASSET INFORMATION SHEET
�rRL=p
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION ,�� � / _ )
Lam/
DEYT. NO.
D
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
•
COST
*PROJECT NUMBER �� //l
PROJECT COMPLETION DATE
COST , t: 7-
B.A.R.S. ACCOUNT NO.'//'BUD
ESTIMATED LIFE c7
INITIATED BY
DATE
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
L "1 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTR
REFERENCE DATE
VERIFIED BY
PROCESSED
BATCH NO.
by
INITI
DEPARTMENT FILE
.. - ,•. i . r'. yn. N,�'� ,�(,i�;,,� � Y!��j r �a��� � T. �"A9,5'� i• �p �« 'k ! .it � ��v ,.T � e% �1"
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CITY of EDMONDS +�,'�$.B��.E SE'WEA PERMIT
For Inspection Call 771-3202 Y 21 oi5iw ERMIT'N0 07751
Address of Construction:L�✓y
Property Legal Description ( Include all easements ) _Ncc .",7
t
Owner and/or Builder: CAN �-. � ��,sa� �o�,X.,coASn \7.
Contractor & License No:
Single Family Residence REC EIV E D
Multi - Family (No. of Units
Commercial (No. of fixture Units )
�— PUBLIC WORKS
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I cer�ify hat I have read and shall, comp y Date
with the items listed on the back.
Permit Fee: 30 CO Issued By:',
Trunk Charge: .Date Issued: e .S A ;7
Assessment Fee: Receipt No.: % 3 8 7
Partial Inspection:
Comments Date Initial
Final Inspection Approved:
Rejected:
Wh.i to Copy - File
Date • Initial
Reason Date Initial
4
i
** PERMIT MUST BE POSTED ON JOB SITE **
Green Copy-'Inspectojr Buff Copy - Applicant
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).