22008 77TH PL W11111111111111
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22008 77TH PL W
CITY OF EDMONDS Permit No. 2.14L
PUBLIC WORKS DEPARTMENT Issue Date •r 2 -14
RIGHT - OF - WAY CONSTRUCTION PERMIT STREET FILE
A. *Address or vicinity of Construction
22008 77'.PL W Plat �L 155--069,005
• Owner:yh;:Shina'ton Natural Gas Co
Name
605 156 AV NE
Mailing Address
Bellevue, Washington 95007
City, State, 'Zip Code
• Permit Issued To:
• Type of Work to be Done:
Install New Service
• Work in Connection With:
❑ Sub or Plat [j Single Family
❑ Comml. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes ❑ No
• Contractor: Same As Above
Name
Mailing Address State License Number
H
UCity, State, Zip Code Telephone Number
a 1r NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
a
¢, B. APPLICANT TO READ AND SIGN
cQ
Q INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
1d against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
O
wUpon issuance of this permit, the contractor is responsible "for workmanship and materials for a period of one year
co following the final inspection and acceptance of the restoration by the Engineering Division.
O
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
'775-2525, extension 220.
I understand that this per st be avaiIM51e at'71 job a or inspection purposes at all times.
_Signature: ate_
Owner or Agent
' THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES tit
' CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By.: 9 ` d � r yid. f '46 J
Time Authorized: Voidafter:3n days
Special Condiaions: <rU,` ✓;'4 _A
';'slime it' J>.t 9 �J
Ammendments:
Permit Fee: nr
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X =
it NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * yt
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund. 111 - Route cony to Street nept.�
I
I Diagram:
r
Contractor called for inspection Yes No
.Mork Disapproved By: Dat,e : BY: Date:
Work Approved By: Date:
Inspector:
Ena. Div. December 19-,
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CITY OF EDMON DS
PUBLIC WORKS DEPARTMENT
TO:
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H
W
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SUSPENSE DATE:
SUPERINTENDENT
Investigate
and Report
Take Appropriate
Action
Prepare
letter/memo
for my signature
For Information
Previously Ref'd
Status of Action?
Return to:
OFFICE ADMINISTRATOR
BUILDINGS & GROUNDS DIV. SUPERVISOR
EQUIPMENT RENTAL DIV. SUPERVISOR
STREET DIVISION SUPERVISOR
WATER/SEWER DIVISION SUPERVISOR
TREATMENT PLANT DIV. SUPERVISOR
COMMENTS:
FROM:
DATE: �• �C ��
CITY OF EDMONDS RECEIVED Permit No.
PUBLIC WORKS DEPARTMENT 4 1982 Issue Date 1.2 -r3- 92.
RIGHT - OF - WAY CONSTRUCTION PERMIT Dir. Of Public works STREET FLE"D
A. *Address or vicinity of Construction o Permit Issued To: AIG
22008 77 PL W Plat # 165-069,005
• Owner:Washington Natural Gas Co • Type of Work to be Done:
Name Install New Service
805 156 AV NE Work in Connection With:
Mailing Address ❑ Sub or Plat a Single Family
Bellevue, Washington 98007 ❑ Comml. / Ind. ❑ Apt. Condo.
City, State, Zip Code • Pavement Cut: ❑ Yes ❑ No
• Contractor: Same As Above
Name
Mailing Address State License Number
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City, State, Zip Code Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this perXusteavai at the job/ to for inspection purposes at all times.
Signature: ate 12/10/82
Owner or Aeent
* THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By
Time Authorized: Void after days
Special Conditions:
Ammendments:
-11 Permit Fee: W301
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X =
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
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