1452 8TH PL S.PDF1452 8TH PL S
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
OUTSIDE X INSIDE ❑ REPAIRS ❑
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HOUSENo.................................................................
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CARDNo. ........................................
EASEMENT No. ... ........................................
.... CONTRACTOR ...... ..TC.f 41......_.— 5 ... _... ................ PERMIT No....� Jr.......
STREET /
AVENUELOT No. ..1..................................................................... BLOCK No.............................................................
NAMEADD ..... .:............._............... ........ ........... .................... ....................... ._....... ....._...
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Date Approved:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ............. ......................................
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SEWER WORK ORDER ISSUED ... ....... .........._......._................ DATE.. ...........1- .�.% L. ...""*.:�":: ..... BY ....... ....: ......
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HT -WAY CONSTRUCTION
RIG 740F CON T ON
"PERMIT
Permit Number.:
Issue Date:.
A. Address or Vicinity of Construction:
C.
B. Type of Work (be specific):
11A IFMA"T%
C. Contractor: + VIC, /A/ Contact.
Mailing Address: C; T_4wr) Phone:
State License #: Liability Insurance .Bond:. $
.7-
D. Building Permit # (if applicable)-. Side Sew6r Permit # (if applicable):
E. Ej Commercial E) Subdivision 1-1 City project tility (PUDGTE, WNG, CABLE;
n Multi -Family Single Family 0 Other.
INSPECTOR- INSPECTOR:
F. Pavement or Concrete Cut *y(Yes 0No G. Size of Cut: U' x H. Cbarge$
k UN A 0-_
APPLICANT TO READ AND. SIGN
INDEMNITY- Applicant understandy and by his ,signature to this application t o hold the Vity ofE� harmlessfrom injurM3,,dhm r claims �f
kind or description whatsoever, foreseen or unforeseen, that may 1 , _ - . — b any
be made againsi the City of Edmonds,, or any of its departments or i
employees; including or not limited to the defense of any legal proceedings including ae/ense costs and attorney fees by reason of granting this permit.
THE. CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA PERIOD OF ONE YEAR FOLLOWING THE Ar T YAMDr/1
TIONAND4CCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED,
BY CITY FORCES, AT WHICH TIME DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Two sets of construction drawings of proposed work required with permit application.
A -2.4 hour notice is required for inspection,. Please call Engineering Division,' 771-0220.
Work and material is to be inspected during progress and at comple'tioh'
Restoration is to be in accordance with City Codes.
Street shall be kept clean atalltimes.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work.shall be patched with asphalt or City approved material prior to the end of t
NO EXCEPTIONS. he working day;
I have read the bove statements and stand the permit requirements and the pink copy of the permit will be
t1m or t .
available on sit above statements
t' for poses.
Signature: Date:
fj W �ontr t or t i . pc o
D
IPRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR-TOOPERMIT ISSUANCE
Eng. Div 1997