17129 67TH AVE W17129 67TH AVE W
City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: 17129 67` ave 4 #107007520
B. Type of Work (be specific): vuRMTT Rf-0c7i' w Tn TmgTAr. r A oar !r.AMr gaps _ GAS i1 IN
172 ST SW and 67th AVE W TIE INTO EXISTING MATN @ Al - W A 1 i' S c /1 ANill RX'i'I lf) 2OG El! RA__
OFFSET MAIN @ +147' W 12' �cjl aaan roc END 6W 1 N to ganye its
per #107007320
C. Contractor: PLXZr SOUND ENRGY Contact: DOWO USITALO
Mailing Address: 1122 751Lh ST SW EVERSTT ,98203 phone: (425) 356-'7520
State License #: Liability Insurance: Bon
• f yr' YC.•'^=, t '&:?'f,�J•'.� . . � S.A • .••'4..
D. Building Permit # (if applicable): % d' sJ Side Sewer Permit # (if applicable): a
0 ❑ � I ' C ty Pr3 e(ct• E]' EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
E. Commercial Sub"division
❑ Multi -Family 11 ❑ Single Family ❑ Other
INSPECTOR-1,Iu�A
F. --PAVEMENT: ❑ YES NO G. SIZE OF CUT X H. Charge: $
CONCRETE CUT: ❑ YES ❑ NO11 no Cllt:'8
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 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 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 certifi �ation verifying completion of the
required training in their"po§session. R
♦ 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 a. plication.
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAICE•THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
� Ai
Signature: 1?E[1KF1 H— Date: 8/17/1999 r
(Contractor or Agent),
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK ,
FOR CIT.)
Approved by: -- Kwv
Time Authorized:- Void After / nQ / DAY' i
Special Conditions:
Right -of -.way Fee: -*7* 19. 010
Disruption Fee/Fund 111:
Restoration Fee:
Total fee:
Receipt No.-l` -
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:
For inspection requirements see Engineering Information Handout.
Y� _
NOTES:
1. CALL 2 DAYS BEFORE YOU DIG 1-800-424-5555
N
SCALE: 1" = 50'
17004
ROPE a ____' R
2" PE IP IMAIN ± 13 ' W q,
MTTI TILT a I 013IT., 1Oro 0
Z-I 1Z�5
8 E-/95
172 ST
END MAIN t 548 ' N, ____' W
i 1 �O
r
60' I
SW 3' PUP
± 197'W,12'S R
2" PE IP MAIN 12' S
R.c4 i
IZaLY
g "r
Pt-'yp •"�5R
b r'mot CO IS,
CITY OF EDMONDS:
Maintain a minimum of 5' horizontal
and 3' vertical clearance from all
city utilities and appurtenances.
Cuts in paving are shown as
Nd _ cuts in paving anticipated.
Notify Engineering Division 24 hrs
prior to construction - 425-771-0220
PROJECT MANAGER: DOUG USITALO - 425-356-7520
GAS MAIN INSTALLATION/RETIREMENT
I
SIZE
--LE--N-GTH
TYPE
MANUFACTURER
I
2"
800'
MPE
I
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
5
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REAL ESTATE/EASEMENT
PERMIT
EDMONDS
-----------------------
q/
/
3
-_/_-/
FUNCTION
NAME
PHONE NO
DATE
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PROJECT MGR:
D_USITALO
-
1
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ENGINEER:
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REV#
DATE
BY
DESCRIPTION
DRAWN BY:
-_-
C.S. -__
()--------
08/17/99
COUNTY
_MER SEC
Work Center
NSNHG
CHECKED BY:
- ---
-----
(___) --------
00/CZ/1
APPROVED
QV-0/ yj
1/4 SEC
SE — 8 —
- - - -
27 — 04
- - - -
OP MAP
156.068
--------
PLAT MAP
158.071
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--- ----
_-
U-MAP# (POWER)
CIR MAP#
CIRCUIT#
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() _-_----_
--
MAPPING:
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JOINT FACILITIES ARRANGEMENTS
UTILITIES
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CONTACT----------
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PHONE#
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PUGET
SOUND
ENERGY
2" PE IP MAIN EXTENSION TO SERVE
17120,17004,17109,17121,17102 AND 17110
67 AVE. W.
INCIDENT#
_ _ _ _ _ _ _ _ _ _
DRAWING# SAP SUPERIOR ORDER#
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