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1433 8TH PL S
890 _ 19C)-
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. C
Issue Date:
A. Address or Vicinity of Construction: VZ___J �� P
B. Type of Work (be specific):
1. '�`'`"
C. Contractor: 1__. Contact:
Mailing Address: " - Phone:
State License #: -"
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
❑ City Project Utility (PUD, GTE, WNG, CABLER)
❑ Other 19
INSPECTOR: I , jk 4 e_o+ {--
F. Pavement or Concrete Cut : Yes ' �(� G G. size of Cut: �— x _,,� H. Charge
APPLICANT TO READ AND; SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees tb 4� 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 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 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read th0b6ve sta
available on site at all ti,
Signature:
n
ALL DIAL -A -
stand the permit requirements and the pink copy of the permit will be
Purposes.
Vz/ — Date:
IG PRIOR TO BEGINNING WO
FOR CITY USE ONLY
APPROVED BY: • ��^ 1 ��r �"
TIME AUTHORIZED: VOID AFTER JQL4 30 DAYS
SPECIAL CONDITIONS: Pl0.VE Mrc.H If
JJI4 3L)-`1(.,
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMrr FEE: 'f
TOTAL FEE:
RECEIPT FEE:
,.
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments
Diagram;
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
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The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
OUTSIDE PL INSIDE 0 REPAIRS 0
CARD No . ..................
EASEMENT No.. ................
OWNER............................................................. CONTRACTOR
--/--// ..... 7 .... .......�. . ........................ PERMIT No.
HOUSE No. STREET BLOCK No . .......... ................
....... ........ #— ..................................................... AVENUE LOT No........... ..............................................
NAME ADD ........ .. 4V.&? ...... . ........................ �—;
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Date
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, .................................
SEWER WORK ORDER ISSUED ................................................
Approved:
DATE- ....... BY
APPROVED
J,k 12 1962