20725 MAPLEWOOD DR.PDF11111111111111
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20725 MAPLEWOOD
DR
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 9�'-/)7?
WueDate:
-PLEWOOD.DRIVE
A. Address or Vicinity�ofConstruction: 20625 MA
90 Q5 B. Type. of Work (be specific) GTt-TO PLACE.BURIED SERVICE WIRE. FROM
CARSONBOX TO HOUSE,.RLOWING 20—F.L.IN ROW, SEE SKETCH,
C. Contractor: —GTE NORTHWEST INCORPORATED Contact: BARBARA TOLLEFSON, PERMIT COORDINATOR
Mailing Address: 22118 20TH AVE. SE SUITE 13JBhone: BARB 488-1642
State License #: BOTHELL, WA 98021 Liability Insurance: Bond:$
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D. Building Permit # (if applicable):. Side Sewer Permit # (if applicable):
E. Commercial- [!I Subdivision City Project Ej -Utility (PIU), 6TE, WNG, CABLE, . WATER)
F1 Multi -Family E]..Single Family' E), .Other: W.O.# 2100-9POOlDB: 241316:'.
INSPECTOR: INSPECTOR: uA; &4
F. Pavement or Concrete Cut: D Yes fflNo') G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AND SIGN
harmi--,� fao.- da
INDEMNITY. Applicant understands and by his signature to this application, agrees t t City ofEdmonds !rju A&damages,or
s b �qlai theCity.fEd' nl�%ra'nyofits'departmentsor
claims of any kind or description whatsoever, foreseen or unfore een, that may e mq!�,eh'Sl mo
employees, including or not limited to the defense of any legal proceedings including defense costs and attorney fees by reason ofgrantinj this permit.
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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 F�E�,,WILL BE HELD I UNTIL THE FINAL S TREETPA TCH
IS COMPLETED BYCITKFORCESAT WHICHTJME�2ftPEBIT�011 CREDITWILL BEPROCESSED'FORJSSUANCE�- T6ff11EAPPqC
�NT.
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 theCity Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand the permit requirements and then�ink cblvyof thepermit willbe
able on'site' 'at s'for' inspection purposes.
avail all time
2-22-94
Signature: "4 Date�
(Contractor or Agerdf
CALL'DIAL-A-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 1, 4;4r- A RIGHT OF WAY DEPOSIT
,TIME AUTHORIZED: VOI . D AFTER. I ELI- DAYS., DISRUPTION, FEE/FUND Ill.:
SPECIAL CONDITIONS: AIA .-RESTORATION FEE:
PERMIT.,FEE:`
TOTAL FEE: 030�72d� 62 A 4e
COMMENTS: RECEIPTFEE:
DATE: ISSUED BY -
NO WORK SHALL. BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
I Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
El NO