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18328 HOMEVIEW
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Horneview Drive
OF EDMONDS SIDE SEWER AS BUILT
ADDRESS' Permit Number
.,483,28 Homeview Drive 9473
HOMEOWNER CONTRACTOR
k:'r,::� Acorn Construction
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DATE
5' 31-01
DRAWN
BY P, Lemcke
LID
NO. 215
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Permit N -0
City of Edmonds o: 0-5'7
RIGHT-O&WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: 1037-,�5 Wmeviev-) PL2=
B. Type of Work (be specific): Szu+A "-� 006t DM;H 60,A�,
C. Contractor: Contact:
Mailing Address:
5A(0C0J3E"PDANk0?r6 9&22�hone: 2-C6 3% - 0-712-
State License #: Liability Insurance: 14E7�- Bond: $
D. Building Permit # (if applicable): 791—de §�ewer Permit # (if applicable):
E. F-1 Commercial Subdivision City Project EJ EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family Other
fNSPECTOR-
F. PAVEMENT: 0 YES NO G. SIZE OF CUT x H. Charge: S
CONCRETE CUT: E] YES NO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by his,lher signature to this application helshe holds the City of Edmonds hd.rmlessftqm injuries,
damages or claims of any kind or description vvhatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, includingbut not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. I -
Traffic control and public safety shall be in accordan " ce with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
Restoration is to be in* accordance with City codes. All street -cut trench work shall _,be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the- permit application.
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
3- 5-01
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
Approved b Right-o f-way Fee:
y
�
Time Authorized-' Void After 0-'5/ 0
Disruption Fee/Fund Ill:
Special Conditions: WOfk AP -PAVED PRA
Restoration Fee:
4 OMME, 7-6 126W
Total Fee: -7 �5
0T, 15';rflN'y)J9z/x ArIAQ tj
Receipt No: 1'70 152-
w1rig KRUSH&) OR—
Issued by
V1 NA el^4*1 lr.o��
7
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WOR
�VOE TO"SSIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
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