210 PINE ST.PDF11111111111111
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210 PINE ST
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RIGHT -OE -WAY CONSTRUCTION*..
'PERMIT --5,73
i Permit Number.
Wue Date:
A. Address or Vici�ity`of Construction: 11-41 Rinp S
9708940)
117 -.1sou I ype of — k— speci c): Lng tg.L 0 Ot Z Pirb Ir LWLU PEI= U
@ 321S C/L Pine St and 259W C/L 3 Ave run north to 12'S C/L Pine
then run W to-366W.C/L 3 Av and 12'S C/L Fine
Contractor: P J Contact: Mxiriam-np Kingghiil!�
I iquad Energy
MailingAddress: 1,�22 75 St SW F%rerett Phone: (425) 356-7500 X7596
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):'
E. F] Commercial, Subdivision [I City Project )CJ Utility (PUD, GTE, WNG,. CABLE, WATER)
0 Multi -Family E] Single Family F1 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: -P Yes ONO) G. Size of Gut,.,x4 x Z_ -)H.) Cha
J rgq-$
t 1,
APPLICANT TO READ -AND- SIGN
-INDEMNITY: Applicant understands and by his signature to this applic r1io"Itoholdt
he City of Edmonds harmlessftom injuries, damages, or claims of any
kind or description whatsoever, foreseen or unfore
,seen, that aylbe made against the City of Edmonds, or any o� its departments or-
ot limited to the dej
employees, including or n 'ense ofany legqrj�c,edil�,"i� luding dfense costs and attorneyfees by reason of granting this permit.
----7--. Not-.
THE CONTRA CTOR-IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONE YEAR FOLLOWING THEFINALINSPEC-
TION AND, ACCEPTANCE O� THi`WORK. &�TIMAiiL;�kESTORATION FEES 'WILL BEHELI) UNTII THE FINAL STREET PA TCHIS COMPLETED
BY CITY FORCES, AT WHICHTTIMk A I --ifdR CREDIT PhLL-BE PROCESSEDFOR ISSUANCE TO THE APPLICANT
\E;iB
Two sets of constructibn drawings.of-,pro'06sed' work re4uire'd with"permit application.
A 24 hour notice is required for I inspe�dtion. Flease . call . the Engine I ering Divi sion, 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 Saf6ty shall be. in accordan&e -with* City regulations as require'd by the City Engineer-,
All street cut trench work shall be patched -vyith asphalt or City approved material prior to the -end ofthe working day;
NO EXCEPTIONS.
I have read the, above statements and understand the permit requi . rements and the pink copy of the permit will be
available on site at all times for inspection purpbses.
Signature:. -
Date:
or
VCALL DIAL -A -DIG PRIOR TO BEGINNING WORK.
FOR CITY USE ONLY
APPROVED BY.
TIME AUTHORIZED: VOID AFTER WAff-ti 2 DAYS
SPECIAL CONDITIONS: M MUM A) 451 fe,_i 1510-.
RIGHT OF WAY
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
T OTAL FEE:
RECEIPT NO.:
ISSUED BY
NO WORK SHALL BEGIN, PRIOR TO PERMIT ISSUANCE