17511 71ST AVE W.PDFIIIIIIIIIIIIII
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17511 71 ST AVE W
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'CityX Edmonds
RIGHT-OF-WAY CONSTRUCTION
PVPM1[r1r- Permit Number. ' 06— —0;y
hisue Date:
A. Address or Vicinity of Construction: - 17511 — 71 Ay V (9610880)
B. Type of Work (be specific): Install- Servfte
C. Contractor: -Waghington Ratural Gas
MailingAddress: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Martamne KingsbuKy _9
Phone: 356-7500 X7596
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Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
0
E. F] Commercial E] Subdivision El City Project [J Utility (PUD, GTE, WN�3, CABLE, WATER)
Multi -Family [:] Single Family Other
INSPECTOR: INSPECTOR: cj� f—
F. Pavement or Concrete Cut: 0 Yes MNo G. Size of Cut: x H. Chargi�,$
APPL ICA N T T 0 READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds)iarmless'fdo- injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen,, that may be made against the City of Edmond;�b,-%Uy of its departments or
employees, including or not limited to the defense of any legalproceedings including defense costs, and attorney fees by reason ofgranting this permit.
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THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS jFdg A PERIOD OF ONE�y FO OWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTiMATEDRESTORATION FEES WILL BE HELD UNTIL THE F11VAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA 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 the above statements and understand the permit requirements and thepink copy of thepermit will be
available on site at all tr u*nes for inspection purposes.
Signature: Date: 4-5=96
Yontracior o� ;Ige�t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:'
TIME AUTHORIZED- VOID AFTER Y 2�_ DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND I It:
RESTORATION FEE:
PERMIT FEE- 0 0
TOTAL FEE:
COMMENTS: RECEIPT.FEE-
DATE: ISSUED Y:
NO WORK SHALL -.BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994