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CITY OF E=rr
COMMUNI 11�p
RIGHT - OF - WAY CONSTRU(
A. e Owner: IVA ic� h 6— V-
City State
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State I Zip
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State License Number ly Telephone 14umb
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Address or Vicinity of Construction: -I, o 5? 1 VU
Type of Work to be Done: np-SLA-k3 W ajaA..' V'�
Work in Connection With: 0 Sub or Plat 5(Single Family 0 City Projects
0 Commercial 0. Multifamily 0 Utility
Pavement Cut: El Y &� N
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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Funds held from the Security Deposit (estimated restoration fee) 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 Public Works: 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:, %'J'J Date: M&��
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
Time Authorized: Void after— —days.
Special Conditions:
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Amendments:
PERMIT FEE:
Security Deposit:
Receipt No.: —
Fund I I I Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 19ZS5
I
3
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not war,rant the
accuracy of anything set forth on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tFe -map(s), including, but not limited to,
th . e location of any sewer stub shown. Such
sewer stubs may or may* not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yee-s o-r officer---) shall be Ha-b-11-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
CMC CENTER — WATER -SEWER DEPARTMENT Call PROSPeCt 6-1107 when work
Is ready for Inspection. (No inspec-
SIDE SEWER PERMIT tions Saturday, Sunday or holidays.) N2 1771
ADDRESS ...........................
...... 1-9.12.0 .. 2n ---- 81-st ... Awnme --- ye�l
OWNER ..... ...Kich-ael .... Likran.de
..... ....... .... .. ...... .... - CONTRACTORJ�rr7l S Ptaima F-i 3 A Service
............. ....... --------------------------------- * ........
Perndssion is granted ... . ...... March 13 ............ ]Lg.- 67 -_, for ..... PAIR or CONNECT a side sewer
------------------- - ................. days, to RE
with City Sewers in accordance with aPplication on file and governing ordinances.
ATTENTION 18 CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the Property may obtain a Permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to Construct Bide sewer In.street area. DO not cover any portion of sewer before it haa been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
N--E No. 3—Top, of side sewer must have at least 30 inches cove rage at property line and 12 inches Inside propeAy line; m1nimum. grade of 2%.
No bends in grade sharper than % will be permitted.
N--E No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5--It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the main sewer or its ap-
purtenances except to Insert the pipe into the wye.