1037 GLEN ST.PDF1111111111111111413
1037 GLEN ST
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Peat Number. 96
>. " •,$Y issue Date:" 1 7b
A. Address or Vicinity of Construction: 10.3 `l G-k..,n P* tLO PC.
f n - p B. Type of Work (be specific): kd/ [��0 ✓fs72 L X V 1�k t dt' W,4.
c. � 18 9 •
C. Contractor: A Contact:'��,t
Mailing Address: P Phone: 4,J - ,5 - 7 7 A — 9 g 3 C/
State License #: 0L `11--1 P P7' !;2� 77 - Liability Insurance: Bond: $
D. Building Permit # (if applicable): N >/R Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family go'gingle Family ❑ Other
INSPECTOR: (iJ/ 4 t 7'-c-v Tj INSPECTOR:
F. Pavement or Concrete:Cut : ❑ Yes , []No G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold 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 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 INSPEC-
TION 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
Two sets of construction drawings 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 trench work 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.
I
Signature:
' Date:
O(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: a t,..'t''C►'
TIME AUTHORIZED: TI) AFTER so DAYS
SPECIAL CONDITIONS: `S f-E- P« ^I
RIGHT OF WAY FEE: 30 ..�
DISRUPTION FEFIFUND I 1 I:
RESTORATION FEE:
T OTAL FEE: 3 V
RECEIPT NO.: " //i%S���IJJ Z—
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES
Comments •
Diagram
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
❑ YES
Date:
Date:
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The City of Edmonds
OWNER
. . ............... .
ADDRESS
Lu
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APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS n
EASEMENT No...........................................
CONTRACTOR ..... -A0 ....................... PERMIT NO. ...
LEGAL DESCRIPTION: LOT No . ................................ ------------ BLOCK No...----...-------......_.._..................
NAME OF ADDITION .... .... I .......
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'IV 0fi .90 70 LI)
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lye 62
7d
Approved:
DATE----- .............. By ... -----------------------
CMq .cE R _ OF E�/HpNDS.
WATERS
R
-- -_7-
WER 111"I PP
la ready for ins 6-1107 when work
PERMIT Ilona SasnrdaY, Bnnday or b u�Pea
ADURF,
aa� i p
.1
--------- '1037 G3en Street
--- 498
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UW Olaf. A . . ............. _. .
Olson----------------
Perrzussioa ..... .......---_.
with ' granted December .__.:-.- CpArItA
City Sewers in accordan 21 ... 19.. 66, CT0B .... Lee j�
ce with
AT2E APPheation ' for ..
NT10N 1g OII f'------'-------
-- -- -. ooley
cAr T y.D �; � . NOTE No: 1 � e owners the property
F°11ow11vc: ue.and governing ordidinan Pam' or Cp E
of
NOTE No. �Pl- to construe=t, des e7Obtain a a Side Sewer
NOTE No. D of full
regard d ..street Permit construct information sewer
No' side sewer njn ?r!g Ordlnance not cove; a4Y inside proPert
E No. q_Z.t,e ehda'in grade arp, .vat 1e�l job •16.p30gand 1teSulationsPOrtio�ingsewe lbefore it licensed
Contractor NOT _
sid
Pail n es in due street m cove Bove _
NOTE No•, n awful to p Proper work 'Prterwhisettied ande1 tied- Property line and 12 inches sewers
w you �jd. must
When
get
..•\ nnZY develo wit surface of 'street to
PrO rtY lice; •n�im
J n�ces except to. ink°fie Pipes intOther o the e e P ovidedY or in tear of � tion. . Originalconditloa. Contractors:shall .grade of
per3n
r to do any work on responsible for
the main sewer or its ap'