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-aa • �7VITY OF EDMONDS . Rermit No. qb' t
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date
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A. • Owner: fDtvA' 0 00-:-ka- I-L B. • Contractor: D Al ,= Fn)?'Fe'1ZP2ISI: S
Name
ame
/`i�! 6 UC;II AU6- �r%z
N ,D. &. c c�
Mailing Address Mailing Address
CA)A . �J S� o �C� /� L c / l
City State Zip Y- ty . State Zip
Ss N 9,(;8-lo3'7 I
State License Number Telephone Number
C. • Address or Vicinity of Construction: _I �( 3�1 r uc t I n ¢fit/IE
Type of Work to be Done: -;A CIA/_a AC-)SOim o M
D. • Work in Connection With: ❑ Sub or Plat g Single Family ❑ City Projects
❑ Commercial ❑ Multifamily ❑ Utility
E. • Pavement Cut: ❑ Y El N F. • Size of Cut: X
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, 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, court costs, and attorney fees by reason of granting this permit.
I
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.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS. -
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: Date:�l�- / D
Owner or Contractor
This Permit Must be Posted at. the Job Site For Inspection Purposes r
Call DIAL -A -DIG Prior to Beginning Work
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APPROVED BY: Ott. 6 PERMIT FEEVI'o0
Time Authorized: Void after K' days. Restoration Fee:
Special Conditions: Receipt No.: 1g'
RELEASED BY: v Date I L 13' d
Fund III Fee:
Street Cut Dimensions: X = $
INSPECTED BY Date /:�/ g3 ,e
NO WORK TO BEGIN. PRIOR TO PERMIT ISSUANCE - e_
Erig. Div. March 1989
FIELD INSPECTION NOW (A I I I - Route copy to Street Dept.)-r
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: — Date:
FINAL APPROVAL BY: _ Date:
Eng. Div. July 1985
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47
CITY OF EDMONDS SIDE SEWER PERMIT
89p.1q oo
Address of Construction: _1 —3
PERMIT N2 8242
Property Legal Description (Include all easements): IF"If - ED
`--1 1 -r N z SEP 5
PUBLIC W0ltXe
EDMONDS� �
Owner and/or Contractor: �f r • E N3-r fZ P }n- 21 5 2 S
State License No.rl) t,mT_ r NI' I S'S N % Building Permit No.
Single Family Invasion into City Right-of-Way:'Ek"No ❑ Yes
❑ Multi -Family (No. of Units ) RW Construction Permit No.
❑ Commercial Cross other Private Property:'XNo ❑ Yes
❑ Public Attach legal description and copy of recorded easement
I -certify that I have read and shI comply with all city requirements
as indicated on the back of th Permit Card.
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
* FOR INSPECTION CALL 771-3202, PUBLIC WORKS DEPT. *
Permit Fee: 3y
Trunk Charge:���
Assessment Fee:
Lid No.:
Partial Inspection:
Comments
Issued By `T7
Date Issued: 15 / 0
Receipt No.: lZ / 57-3
Date Initial
Reason Rejected: Date —Initial —
Final Inspection Approved: Date _3' Initia sr� // `
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3.190
The City of Edmonds Side Sewer Drawing EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION ❑ REPAIRS LID NO. ------------------ -ASMT. NO. ..................
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR------------------------------------------------------------.............. ------ PERMIT NO. b-T- -
JOB ADDRESS T v 1----------•------U----•----------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO. -----------------------------------
------------------------------------------------------------------------------------ ----------------------------------------------------------------------------
NAME OF ADDITION ------------ ------------------
1 [TREZIVIENT
PLANT
I\1 JAI C69-1) l of 140,SL
4 u C coo �, r � , �yt'.✓.� d(o
4 Y c� �o C of gtno*,
0
PWW-0001-11/75 (REV.11/78)
1 vy\4.' -� CAo
Approved:
DATE (�----------------