1010 OLYMPIC AVE.PDFIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII12426
1010 OLYMPIC AVE
-4
61 9 0 -_ 1 9 9 -.
City of Edm'oftds,
STREET
RIGHT-OF-WA
Y .CONSTRUCTION
FILE
PERMIT
Permit Number: q� ?3'
Issue Date: 7ql-:),
A. Address or Vicinity of Construction: 1010 Olympic Avenue
_13. Type of Work (be specific): Install New Service
C. Contractor Rash. Vat'l—Gas Company Contact: Frank Swan
Mailing Address:815.ljerc_r sj.spattjp, Wn Phone: 224-2278
State License#: 98111 Liability Insurance: Bond- $
D. Building Permit # (if applicable): Side Sewer PermiQ# (if applicable):
E.' Commercial ❑ 'Subdivision El City. Project (Utility (PUD, GTE, WNG, CABLE,*WATER)
❑ Multi -Family E] Single Family ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut E]Yes fRNo G., Size of Cut: x 11 Charge$
APPLICANT TO REA SIGN. 4* C,
INDEMNITY. Applicant understands and by his signature to this application, a e t hold the City of Edmonds harmles2ft4lj �,n ls� �aes, or
claims of any kind or description. whatsoever, joreseen.or unforeen, that may be m e ainst the City of. Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any !egal proceedings including difens'e.costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS . F . O�A . ��RIOD OF ONE YEAR FOLLOW_N� ihi Pil& INSPECI70N
AND ACCEPTANCE OF THE WORK. ES77MA TED RESTORA77ON FEES WILL BE JkL5"'VN77L THE FINAL S77ZEET 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 Departure
Work is to be inspected during progress and at completion.
Restoration is to be in accordance With City, Codes, 771-020
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the C-i(y''E0ki neer.
All street cut, ditches shall be patched with'asphalt or City approved material prior to theendof the working day;
NO EXCEPTIONS.,
I.have read . the above statements and Understandihe permit
t . t requirements. and the pink copy of the permit will be available
on site at all times for inspection purposes.
Signature: Date: July IR, 40999
(Contractor or Agle'�,��
CALL DIAL -A -DIG PRIOR TO BEGP041NG WORK
NGWORK SHALL BEGIN, PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund III Route copy to Street DepfA
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July
l
Vlfasttingbon=
Naturat Ges
&19 • JM-6MovcxvjMW I
1010
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by:
Engineering Aide
�s
qPl WNG. to window
unknown depth
Z " gas main
ney:
-w- water
-g- gas
-ss- sewer
way
by
MS MUCW St (P.O. BM 1E69). Sa=ie. DNA 95111 C206) C2.676:
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ........................... ..............
NEW CONSTRUCTION E) REPAIRS 0
118-08900
OWNER.......... DaKi.d ... Kelsan ............................................................ CONTRACTOR .................................................................................................. PERMIT No . ......................
AbDRESS ...... KNAlympIc ... keaug ................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No. ............................................
11
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................