1053 OLYMPIC VIEW DR.PDF14292
1053 OLYMPIC VIEW DR
�,..._ _ CITY �Or", .EDMO�JDS §�EET FILE
PUBk,", WORKS- DEPARTMEtJT ENGTNE ING DIv'
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APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT'
THIS PERMiIT MUST BE AVAILABLE AT THE JOB SITE FOR .INSPECTION PURPOSES
Applicant .to Complete Parts A and B
A, Permit t-o be issued to: Snohomish County P.U.D. #1
For Work at :.(address or. vicinity);do5.3
Type of -Work to be done: Txench ivy ';e . of U> . — u/. O: 98 Z SS I
(attach drawing when applicable)
Time Required -- Start: 1-day Finish:
Owner. Snohomish County P.U.D. #1
Name
2.1018 Hwy 99
Mailing.Address
Lynnwood, IVA 98036 774-2112
City State Zip Telephone Number
Contractor: same as above
Name
State License Number
Mailing Address
City State. Zip Telephone Number
B. INDE*LNITY: 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 applicant or 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, 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 subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775=2525, ext. 220.
-I understand *that this .permit must be available at the job site for inspection
purposes at all times.
Signature: /JA G Date: Z -/Z-74
Owner .or Agent '
C, 'TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: __2-�2-0. Permit No..: Fee:
Security Bond:
Time Authorized:
O
APPROVED BY Date •
111-771,. 14i n.,A -
1019 'PUBLIC UTILITY DISTRICT -No. 1 of Sh L mish County_ ,-_ �_ . AT AREA
0 5 Location
L,;) 1,A Do-
W.O.No. 9 9
-SL1/4 J S 2-1 -:I_R r5VVY-l-') -Revision
Scale I" - 'I
Reason for work 'T-N CA.:P7. ::Engineer✓
51 AsiBuilt —
4 c --)
U.G. File No.
y%)A:T-Efe-_, 2A Le -%A/ A r-. Approvals
-PERMIT REQUIRED -FOREIGN CONTACTS EASEMENT
ENVIRONMENTAL ANALYSIS
Type CITI,- QE =1>hA Company Cant 'niu_
Exempt under.District SEPA
J.RN.No.
-procedures, Section 11,1--!A
Date Granted Grantor
. Fees required Yes® NoO
Paragraph_,Item C-
Log Posted
Tronsf-Cord
Inventory
Pole Dept.
Type 72E-= r;,, -f- 71KAT. - Raic-tranted
Date %'Z. Amount 21 S;.
Date 1;_1 e:) By—'ULL
Interpretation Referred To:
Map Pas
Circuit
Date Released For Construction
'Date gy
Date Mbrk Completed By Foreman .
-Circuit Number Substation 'hAA-7-)_Qy%jr_)a n
O.H. U.G.- Cond
Add Ckt -Fr':� P"
Remv lEict Ft PH.
Ckt Ft.
Water
Sewer
_41 Gas
IS, Backhoe
A ` �. C,�/
AREMOVE 5. .................. . . ........................ ........ >
Te
H A N1 G A .... ...... XVA 7200.
.120 i 240 V. TRAN"F
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