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20911 82ND AVE W
t�'C I T Y�- Permit No-.
.vP,F EDMONDS
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COMMUNITY. SERVICES DEPARTMENT RE.CZ, ve D 4 - cl
RIGHT-OF-WAY CONSTRUCTION PERMIT Iswe Date
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Washington Natural Gas Company
A. 0 Owner: r-NMVP
�Wmercer Street t6Qractor: Name
Mailinp, Address Mailing Address
Seattle WA 98111 GW.R�
City State Zip C_ City
State. Zip
PAV State License Number Telephone Number
C. 9 Address or Vicinity of Construction: .20911 82 Avenue West
To Inst 11 2" PE IP Main in.82 Avenue West. Per Addached
Type of Work to be Don
Drawing: 812-524 (IR 6043-3) (1)
D. 0 Work in Connection With: El Sub or Plat 0 Sing le Family El City Projects
El Commercial El Multifamily 0 Utility
E. 0 Pavement Cut: XY 0 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, 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 depa'rtm2nts - or employees, including or not limited to the defense
of any legal proceedings including defense costs, cd .('�osts n,,at(6—hiey fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR . R MANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION. AND ACCE.PTANCE 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.
• 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:
Date:' March 29, 1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: IT141
Time Authorized: Void after —JUNF— 67 days.
Special Conditions: m A
PERMIT FEE:
Restoration Fee:
Receipt No.: —
Fund I I I Fee:
Street Cut Dimensions: — x = $
RELEASED BY\-,\ Date q__ INSPECTED BY Date
.NO WORK TO BEGIN- PRIOR. TO PERMIT ISSUANCE,.
rrig, Div. March 1989
FIELD INSPECTION NOTES
(Fund I I I Route copy to Street Rept.)
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Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
0 YES
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
0 NO
Eng. Div. July 1985