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1312 OLYMPIC AVE
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City of Edmonds STREET FILE
RIGHT-OF-WAY CONSTRUCTION.
PERMIT
Permit Number.
Issue Date: —
Js
A. Address or Vicinity of Construction: 1312 OLYMPIC AVE
f 8 9p 19 C B. Type of Work (be specific): GTE TO PLACE BURIED SERVICE WIRE FROM
-
PEDESTAL TO HOUSE, PLOWING 80-FT IN R.O.W. SEE SKETCH.
C. Contractor: GTE NORTHWEST INCORPORATED Contact: BARBARA TOLLEFSON, PERMIT COORDINATOR
Mailing Address: 22118 20TH AVE. SE SUITE 1-IMone: BARB 488-1642
State License #: BOTHELL, WA 98021 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other WZO # 2100-9POOIDB 242310
INSPECTOR: INSPECTOR: uy�; i'
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Curt: x/ H. Charge$
APPLICANT TO READ AND S ',N
INDEMNITY: Applicant understands and by his signature to this application, agrees to hol _ e City of Edmonds harmllAyo4-44 damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad` r ,ns��the City of F.dmonda, or%% j its epartments or
employees, including or not limited to the defense of any legal proceedings including de . 'e �;Jand attorney fees by reaHon, granting this permit.
l . ' r' a,
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES -WILL BE HELD UNTIL T/jF. FfNAG STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE O 7'hdABP�I /CANT.
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 Citx.regulations as required by.t4e City JEngineer.
All street cut ditches 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.
Signature:R Date: 11-12-93
(Contractor or Ag . t)
COMMENTS:
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
DATE:
rnniviai nr.r.:
— TOTAL, FEE: tJ�� / �i�(L 'e
- RECEIPT FEE:
,- 4,
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
EnArg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
11-10-93 03.20 PM FROM Hallslake Const.Yrd. P003 •!
IZL
7Z7 -
' - 5) nof
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
119-02050
OWNER.---......$......V Grike ewald......................................................... CONTRACTOR....----........---..........................................---.........---....................-- PERMIT No.......................
ADDASS ...... 1312_.01_ympl C Avenue .............. LEGAL DESCRIPTION: LOT No.............------.... ............. BLOCK No. ---...................-----.................
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NAMEOF ADDITION.........................................................................................................................................
Dye Tested On Sevier 1972
Approved:
DATE................................................ By.....................---................................--............