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23500 84TH AVE W23500 84TH AVE W ;. j890 19C0 •`�?' eq )��i:.i '•'`%- ,} $. ;:'R ?a.:,�:,r�. .. r�x , 1 u _ j...r,-a•,^^,.•a.rn..g.;,�,• -r�7"k .���L ��� �tf. � City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT permit Number. Issue Date: A. Address or Vicinity of Construction: 23500 — 84 AV W (9722950 ) B. Type of Work @e specific): Relocate with 2"Plas tic Gas Main per attached &W# 9722990 to conform w/ City storm r>rain Prn1Pet C. Contractor: Puget Sound Energy Contact: Tom Ling / Daniel Chan Mailing Address: 1122 75 St SW Everette Phone: (425) 356-7530 State License #: 98203 Liability Insurance: Bond: S D. Building Permit # (if applicable): ` E. ❑ Commercial ❑ Subdivision ❑ Multi -Family ❑ Single Family INSPECTOR: 4• Side Sewer Permit # (if applicable): ❑ 'City Project ® Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Other INSPECTOR: F. Pavement or Concrete Cut: ❑ Yes ®No G. Size of APPLICANT TO READ AND SIGN# H.,rCharge ,,,; INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the.Cit�of Edmonds harmless fi om 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 legal proceedings including defense.,T ts; d attorney fees by rgasQn ofg� a jing 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. 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 the permit will be available on site at all times for inspection purposes p g�4� /17 Signature: Date: (C tract Agent) / t CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: I IL', RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFTER Z Q DAYS SPECIAL CONDITIONS: 1xi ��1es' COMMENTS: DATE: DISRUPTION FEE/FUND 111. . RESTQRATION'FEE:' PERMIT FEE: TOTAL FEE: 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 ❑ NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: / I -VITA/ TO /. �1 4-17 AT Y /76' C' /r. f20'/v /� 'l, • , Z" 11 - /.'/7 N M�n s/^7/ZS M /99z N I .9.�i tSJlve >EIT /� T//F'� r,;'� - -- --J All 011-11'5�5-T 2"'pr_ /n //r/'1/A/ --- TO /_Slc1 /,/? 47- / ME O o To /3E CET/QEl� — Z " -<,/ /G /-/LI/// ClYJ.CC ..S'�G'>inn/ L � n er \ ,,, —'.^"""'^t r—'_"{:;. fvk J�, � ,�i f)• k �-+ � � + r _y_ � '� �.�,,•rf� plr,�t. �y T �-L�� -9' �n�—�' ` it � j -4r i Aka k k-Y �•.-. i�'%1'� .`, ,1'�'�, i.. ��.rM1 '4"3 -y — /t� L � �i �251 i+,- �. Ir'* Ai• �� I � .1 5 � ':JI' l'i IT r�i'}yyr • Ci'�''��� C 1 O MCA& NO TES 1. NOTIFY ONE CALL 48 HOURS PRIOR TO DIGGING A7' 1-800-424-5555. A 2. NOTIFY TOM LING, PSI; PRO.IT%C7' ATANAGER AT (425) 356-7530 PRIOR TO ANY CHANGE,& F EDMONDS INSPECTOR 24 HO URS PRIOR TO 3. NOTIFY CITY O CONSTR UC'77ON AT (425) 771-0220. 4. CALL DON FEINE OF CITY OF EDMONDS AT (425) 771-0220 TO VERIFY DEP7'II AND I OCAT ION OF PROPOSL;'D S7'ORMDRAIN PRIOR TO TIE-IN. 5. # # ## # DENOTES EXISTING ACTIVE SERVICE. O 6. RETIREAI,I_, IN1IC71VESTUBS. No. DESCRIPTION DATE BY APP'D REVISIONS AS BUILT INFORMATION FITTER OR CONTRACTOR: COORDINATOR: F E DATE COMPLETED: PERCENT COMPLETED: TEST _ INSTALLATION / RETIREMENT SUMMARY TYPE OF TEST: PPESSURF: L D DATE ON: TIME ON: I / R MAIN SIZE MATERIAL TOTAL FOOTAGE DATE OFF: TIME OFF_ — TYPE OF PIPE: ,4- PII'E MANUFACTURER: -- -- - - TESTED FM L T(� 1. 1!1 rtlr�l.l ,,alarmG ; _� OP rAAP: PLAT MAP: /G6-p68 ' WORK AREA: S// PROPOSED MAIN FOOTAGE EMERGENCY SEC. No.: MAIN SIZE MATERIAL TOTAL FOOTAGE DESIGN PRESSURE: Ma DD Z" MPE 350 SYSTEM MAOP: PsIG IG E -- -PS PERMITS: - G N 2 /1P1IAN ���OC147- AT ,236-00 "' 9 All A/ DRAWN: PCH41,1 9'0S- &I7 JOB No. CHECKED: ��E DRAWING NO. --l��22 !,5 / / _ APPROVED: - >'��----- 1ii f AM, RaAIA �_ A/ lW j m M /9Bo �5 Z" 9/-/D/ZT.STG3 , M,q/1c/ To 4� AT a /76' C �r: K4 d /All 17 T/a Co �ir�C �7 SE7' 7 Pr-,//' /11 Vv-/ - - - - To /.Sk/ ? 47 f 7i '/✓ G7 " �i/ADC TC'7'(�✓� ST-f: ,Z6 A �:ZO 3dz. 4f�w�7fi ': a•?N�• s TD /36 ,SE7_1,a_E1'-" - Z " <W-/ /!' /_/A/rc/ sEE" T5'�il/T L /6" ST</ /H/' //%//A APICA6 eWss sC(f r1oAJ /P I-IAIA/ 4,..er `Y L r 5=�� a 4: { " ;y �r 1,4j�, {`� i+x - t y 4���Z r}3 � r ,, � w�a,V�^•,,� -�L .t,. L ,a rt-S1 C.\ � }.,�7. �'k�L�l", x �•Mr�� r � . ''� 1'La�"9 3 ir"` `��. %S ^F 5 l �w�rA''���'�R' > N r. s �* 1 1 . NOTES I. NOTIFY ONE CALL 48 HOURS PRIOR TO DIGGING A7' a 1-800-424-5555. 2. NOTIFY TOM LING, PSE PRO.IECT MANAGER AT 425 356-7530 PRIOR TO ANY CHANGES. 3. NOTIFY CITY OF EDMONDS INSPECTOR 24 HOURS PRIOR TO CONSTR UC7'ION AT (425) 771-0220. 4. CALL DON FEINE OF CITY OF EDMONDS AT (425) 771-0220 TO VERIFY DEPTH AND LOCATION OF PROPOSED STORM DRAIN PRIOR 7O 7IE-IN. 5. DENOTES E'XIS77NG ACTIVE SERVICE. 6. RE71RE AU, INAc777VE STUBS_ 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 i R MAIN SIZE MATERIAL TOTAL FOOTAGE DATE OFF: i TIME OFF: ' TYPE OF PIPE: PIPE MANUFACTURER: TESTED BY: � 1 co voy iNiiu.r IJ�a L�vo1TG�.•n OP MAP: PLAT MAP: __ _ WORK AREA: PROPOSED MAIN FOOTAGE EMERGENCY SEC. No.: MAIN SIZE MATERIAL 'TOTAL FOOTAGE DESIGN PRESSURE: PSIG p -7 MPE 3S0 SYSTEM MAOP: PSIG PSIG E PERMITS: C/Tj� D� E�Iorl' j-S� S v N 2 "'' - P 1IAN 1( GZXA7(�_ AT 23,5-00 94 AV Al DRAWN: 6?'ZS-97 JOB No. 972Z /5'0 CHECKED: E r7 DRAWINGNO. 9722950 / �/ APPROVED: %1Z�-- �S' 1(, J'7 NOTES /MPROl 11-1 /, A/ a// SrT 2 "mac //c� MAIM TO /S Al 4-17 AT :e /76'S 0 N s/3 ? /99z TEST T/E ee-�X- - J sC�vie To NEa./ I -'I JIA/ I I v✓iTi� �� �A,�IE Z" :!l (TO n/S7�?Gr.gTiOrc/ ` d• t f ?; I VVI Q III II , ( \ u, s Zz' P<1 ✓ivy Z"/'c/PAA/v O o O TO I.?C PET/QEI�> T/-/F /6" STIJ ///' P71-11// SEA' 7Y/'Il4 acm 7PYP/CW- elCasg s(f r10Ay 1. NOTIFY ONE CALL 48 HOURS PRIOR TO DIGGING AT 1-800-424-5555. 2. NOTIFI' TOM LING, PSE PROJECT AIMATAGER AT (425) 356-7530 1'R10R TO AAT) 'CIIANGES. 3. NOTIFY CITYOF EDMONDS INSPECTOR 24 HOURS PRIOR TO CONSTR UCTION AT (425) 771-0220. 4. CALL DON FEINE OF CITY 01,EDMONDS AT (425) 771-0220 TO VERIFI' DEPTH AND LOCATION OF PROPOSED STORM DRAIN PRIOR TO TIE-IN. 5. # #1 #t #f DF,NOTE-S EXISTING A CTI VE SERVICE. 6. RETIRE ALI, INACTIVE STUBS. No. DESCRIPTION DATE BY APP'D REVISIONS AS BUILT INFORMATION FITTER OR CONTRACTOR: COORDINATOR: F I E DATE COMPLETED: PERCENT COMPLETED: INSTALLATION / RETIREMENT SUMMARY TEST TYPE OF TEST: PRESSURE: L DAT E ON: TIME ON: I / R MAIN SIZE_ MATERIAL TOTAL FOOTAGE D DATE OFF: TIME OFF: TYPE OF PIPE: PIKE MANUFACTURER: TESTED BY: —_ K fl� SO�INJ' Qi` 11JI Il(.Y iii.wxlMy�a+= O�N�� TIO�a`\ OP MAP: F ' LA r MAP_ /66-068 114 SEC: /Vll/3/-Z7-Q- WORK AREA: ` PROPOSED MAIN FOOTAGE EMERGENCY SEC. No.: MAIN SIZE WTERLAL 'TOTAL FOOTAGE DESIGN PRESSURE: PSIo D Z_— �— /`�/'E — 350 SYSTEM MAOP: PsIo PSIG E - --- - PERMITS: C17-Y DF — ---- N 0(7 14/ 2 00 1v -tq4, AV W DRAWN: )>CH41-1 9-ZS-97 JO©No. 97.0, CHECKED: f — 9 17 DRAWINGNO. 9720950 / I / APPROVED 1-Z� 16 j %