18000 76TH AVE W.PDFIIIIIIIIIIII
6227
18000 76TH AVE W
CITY OF EDMONDS
D/NEW
ADDITION
RETIREMENT
ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
DEPY. NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
I
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
2�
INITIATED BY
DATE
PROJECT NUMBER
PROJECT COMPLETION DATE
COST
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SLIBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
D"DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
Mp) INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
DEPARTMENT FILE
IJ
>4
Z
0
W
V)
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Ix
0
L1.
G4TY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
Permit No.
Isv Date
A. 0 Owner: eA6Mdi&Z_S (1&6 ac B. *Contractor:
Na, Name
- !� 3 --a, ft� t'� P. c�. 5 -7
Mailbug Address M flina Address
— EDY)DkOs .. (. 9 ('30, 9
City State Zip City State Zip
State License Number Telephone Number
C. 0 Address or Vicinity of Construction: 76' 5— 1
Type of Work to be D�n'e. S-L*A 0*Ar % .'.4 0'M Ktai6
<1r-fL%1\LC Tb i&Qc,. -7 C-r' Au,<- L.,k S
*1,<' r--444L
D. 0 Work in Connection With: El City Projects
gr �<Single Family
"Plat
El Commercial 0 Multifamily 0 Utility
E. 0 Pavement Cut: 0 Y S(N F. 0 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,-dimages, or claim's 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.
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.
6� Street to be kept clean at all times.
6 Traffic Control to be in accordance with City regulations.
9 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand th�labove and that this permit must be available at the job site for inspection purposes at all times.
Signature, Date:
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior.to Beginning Work
APPROVEDBY: W
Time Authorized: Void after 30 days.
Special Conditions: Mo :5T?,EeT- C-025 ALLOWED.
RELEASED BY:
PERMIT FEE: 0-30- tx-_ '6a Z 4, &_ _'_O/
Restoration Fee: —
Receipt No.: —
Fund I I I Fee;
Street Cut Dimensions
Date INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
x — = $
Date
Eng. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept-)
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985