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1231 12TH AVE N
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City of Edmonds
y RIGHT-OF-WAY CONSTRUCTION
.�
PERMIT Permit Number. 9 27
Issue Date:
A. Address or Vicinity of Construction:
18 C B. Type of Work (be specific): Ll e �OGg! eXlS�' i O/G Gt1 ii�/� h �W y0
9 0 - 1 9 Pot'G ArJG! C�o/�. QGra�tS /a-� �vG /Yoram, urG wool t•� a 2X�sy-iµ�
ar,Q( -Pd faadj�R nei�e/urn acrnss rood ao as S,ERa/.'
C. Contractor: PILO Contact: y/G �
Mailing Address: Q161S Jw„ �� ,E�/�,,,�s Phone: %U f
State License #: 9Baab Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewdr Permit # (if applicable):
E. ®,-Commercial ❑ Subdivision ❑ City Project E34Jtility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: OJ41�1&AAA.t INSPECTOR:.
F. Pavement or Concrete Cut: 91�re-s ❑No G. Size of Cut: -3' x $ ` H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees 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
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE. FINAL STREET PATCH
IS COMPLETED BY CITYFORCES, AT WHICH TIME 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 byth .C'ty �yn-gineer.
All street cut ditches shall be patched with asphalt or City approvecr4iiaterial prior to the en dt�e w orking 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 ins p you purposes.
00(
Signature: Date: OZ&
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: hft�e RIGHT OF WAY DEPOSIT P6 r
•r{J (lens, Y
DAYS DISRUPTION FEE/FUND,111:
TIME AUTHORIZED: kD6AFTER
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:
TOTAL FEE
COMMENTS: RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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:
❑ NO
STREET FILE
CRTY OF EDMONDS
250 51h AVE. N. • EDMONDS. WASHINGTON 98020 • (206) 771.3202
COMMUNITY SERVICES
February 24, 1988
Geo J. Stoss Sr.
1231 - 12th North
Edmonds, WA 98020
SUBJECT: CROSS CONNECTION/IRRIGATION SYSTEMS
Dear Mr. Stoss:
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
An irrigation system located on your property may be in violation of
State of Washington and City of Edmonds ordinances related to backflow
prevention. To protect the potable, or drinking water supply, an
approved backflow device.is mandatory on all irrigation systems.
Please call the Water Department Cross Connection Inspector, Scott
Highland or Lee Willeiksen, at 771-3202, extension 291 or 294, for
information or an appointment for inspection of your irrigation system.
Requirements to meet State and City Codes need to be completed thirty
(30)days from receipt of this notification.
Sincerely,
Archie Brena
Water/Sewer Supervisor
SH/lk
STOSS/TXTWATER
PUBLIC WORKS PLANNING PARKS AND RECREATION ENGINEERING
APPLICATION
City �� for
The of Eiifl1;' - SIDE SEWER PERMIT
�-..- EASEMENT No . ..........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
119-01450
OWNER........... riEQ...A.---Stoss-SI:.------------------------------------------------------ CONTRACTOR.....................................--......................---.................................. PERMIT No. ......................
ADDRESS .......1.2.31.... 1.2th. AVeIIUe........................................................ LEGAL DESCRIPTION: LOT No. -----•..........----.. BLOCK No. ............................................
i
0
s
•
NAMEOF ADDITION.............................•--•-.......................-----•----......................................................................
Dire Tested On Sewer 1972
Approved:
DATE..............................................- By.................................---..................................
' 2-50' OF- Z
PVG BY PUP
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