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RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 2..
Issue Date: C)Y—
A. Address or Vicinity of Construction: T I
--1A
B. Type of Work (be specific).
C. Contractor: 1--- Contact: �Wz-e'4 cvk
MailingAddress: Phone: qr7 8-0
StateLicense#: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):.
E. F-1 Commercial E] Subdivision E] CityProject F
I _] Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family - KSingle Farni y Other
INSPECTOR: �:T INSPECTOR:
F. Pavement or Concrete Cut Yes /^QNo G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
,kind or description whatsoever, foreseen or unforeseen, 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 and atiorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL'BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 the City Engineer.
Al I street cut trench work shal I be patched th asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.,
I have read the above statements and understand the permit requirements and the pink copy of the permit will he
available on site at alL-tim—es—Vr inspectioi;�06se-s-'
Signature:
ontra&or or Agent)
Date: �zl./A 7
/ ' I .
DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
Z,
APPROVED BY:
TIME, AUTHORIZED: VOID AFTER, DAYS
SPECIAL CONDITIONS: rdl) �-A-V- V-)AA 14 0 0 1
- - ' * a— — 4
VL
RIGHT OF WAY FEE:
DISRUPTION, FEE/FUND 111:
RESTORATION FEE:
T OTAL FEE:
RECEIPT NO: A?—
.-11.'
GXV'77 'w— X 7
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments -
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
uymwl P"ING, INC. -,P ASPHALT PAVING
P.O. Box 438 BID PROPOSAL
Lynnwood,WA 98046-0438
Phone: (206)778-3126 Date: 5/6/97
Fax: (208)775-1811
TO: Warren Highland
21105 81st Pl. W.
Edmonds, WA 98026
Phone: 425-778-0381 Fax:
SITE: Same
Excavation: Remove weeded existing crushed rock and dirt, load.
and haul away. $ 495.00
Place 2" base course crushed rock, compact, soil sterilize and
pave with 2 1/2" Class "B" Modified asphalt hot mix.
Approx: 114 square yards @ $12.00 $1,368.00
Total $1,863.00
NOTE: Area or areas to be agreed upon or measured on completion
and billed at the above UNIT PRICE of actual asphalt installed.
PAYMENT DUE UPON RECEIPT OF INVOICE * ALL PRICES PLUS TAX
NOTICE M CUSTOMER: This conlraclor is regi-10 I with the State of Washington, Regi.b. n No. OLYMPPI077LD, Exp, June tat as a specialty contractor and has posted with the State a bond of cash deposit
of S4,000 for the purpose of satisfying claims against the contractor for negligent or improper work or breach of contract In "conduct of" oonbactor4s business, This bond or cash deposit may not be sufficiervt to
cover a claim which might arise from the work done under your contract It any supplier of materials used in your construction project or any employee of the contractor or subcontractor is not paid by the contractor
or :uboonbactor an your job, your property may be liened to force payment If you wish additional protection, you may request the contractor to provide you with original "lion release" documents from each supplier
or ubcontractor on your pmject The.contractDr is required to provide you with further information about lion release documents R you request it General information is also available from the Department of Labor
and Indu` ',
PERMITS: If required, will be the owners responsibility. We shell not be liable for damage to or breakage of septic tanks, underground pipes, andfor conduits not visible from the surface of the ground not for any
damage to approaches (Including sidewalks) frorn Me shee to the property line. We cannot be responsible for subgrade failures or willing of subgrade material which was not installed under the above
agreement Soil sterilization (weed killer), if not included In the contract, will be applied at rates specified by manufacturer. Olympic Paving, Inc., will not be responsible for any subsequent growths of horsetail
weed, morning glory. deep rooted fems, or perennials, which have not reached maturity prior to application. All material !a guars.. as specified. All work to be completed In a workman -like manner according
to standard practices. Olympic Paving, Inc. accepts no responsibility for any work other than the specifically described above. Any additions or afterstions of the above work will be executed only upon written
orders and may becon an additional charge. All agreements are contingent on strikes, accidents, delays of carriers, and other delays unavoidable or beyond our control.
A Late payment charge may be made on any past due balance, which the low calls a *FINANCE CHARGE*, AND IT IS COMPUTED AT A MONTHLY RATE OF 1 1/2% (ANNUAL
PERCENTAGE RATE OF EIGHTEEN PERCENT). ft Is agreed that In case sult Is instituted to collect amount due on this contract or any portion thereof, reasonable attorneys fees and
court costs may be added to this contract.
AN AUTHORIZED SIGNATURE ON ONE COPY, RETURNED TO US, WILL MAKE THIS A LEGAL CONTRACT PENDING ACCEPTABLE CREDIT APPROVAL AND WILL BE
REQUIRED FOR SCHEDUL114G OF WORK. PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN 30 DAYS.
X 41ta ai. X
OLYMPIC PAVING, INC. DATE CUSTOMER AUTHORIZED SIGNATURE DATE
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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 �Edm.onds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
mation shown on
inquiry regarding the
t-F e -map(s), including, but not limited to,
the 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
ernpl-o-yee-s o-r offiCle-rs -S'h-all be H-labli-e for the
information given on this map(s), nor for
ation provided based
any one represent
upon said map(s).
STREET FILE
The City of Edmonds
APPLICATION
for
SEDE SEWER PERBUT
OUTSIDE E] INSIDE [] REPAIRS
CARDNo . ......................................
EASEMENT No . ...........................
RIMW No.
OWNER..... ...... OYMACTOR ................... -64-5. � -------------------------------------------- ............
................................. 06;&*�'
TREET
............................................................................ Z.- UE LOT No. 13
HOUSE N�� . ....... AVEN ............. ...................................................... BLOCK No. '4;22r-�� --------------------------
02 Flo NAME ADD . ........................................................................................................................................................
10
BACKFILL WORK ORDER ISSUED
SEWER WORK ORDER ISSUED .....
/r
/7-
Date Approved:
........................ DEPOSIT, $ ............................................
........................ DATE
-- - - --------
APPROVED
By................
EDMONDS
TY OF
C1
CIVIC CENTER WATER -SEWER DEPARTMENT
SIDE SEWER PERMIT
Call PRospect 6-1107 when work
Is ready for Inspection. (No Inspec-
tions Saturday, Sunday or holidays.) N2 1151
ADDRESS .................................... 4.21 ..... ... 1.9t.h .... Pi.a.ce.... South
.. .... .. .. .... .. .... .. .... ..................................................................................... ..................................
OWNER ..................... Kias....Agne.s .... Spatz ............................... CONTRACTOR ........ H.U.5k.7 ..........................................................
Pernilssion Is granted ............ Apg!�s " t_1 , 2 ........... 19..�-, for ...................... days, to -REPAIR or CONNECT a side sewer
with City Sew . ers in accordan.ce, with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer'in
side.property line. A licensed"Side Sewer Contractor must
'be employed to construct side sewer In street -area. Do not -cover any portion of sewer before it has been Inspected.
NOTE No. 2—Obtain full. Information regarding Ordinance 11.16.030 and Regulations governing side sewers. when
you get permit.
NOTE No. 3—Top of side sewermust have at least 30 inches coverage at property line and 12 inches.inside property line; minimurn grade of 2%.
No bonds In grade' sharper than 'A will be permitted.
NOTE 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 impmper 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.