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21208 96TH AVE W
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6,ry OF EDMONDS STREET FILE
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. * Owner: Washington Natural G�s o B. 9 Contractor
Name
865 156 AV NE
Mailing Address
Bellevue, WA 98007
City State Zip
Permit No. "_3_T41
Issue Date X09
Same
Name
Mailing Address
City State Zip
447-0700
State License Number Telephone Number
9 Address or Vicinity of Construction:_ , 2120-g-,96 AV W
Type of Work to be
'a�dservice instalL
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Work in Connection With: 0 Sub or Plat
� El Single Family El City Projects
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Pavement Cut: 0 Y 0 N
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APPLICANT TO READ AND SIGN
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< INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
>4 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
"4 YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
0
U 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.
0
* A 24 hour notice is required for inspection; Please call Public Works: 771-3202
e Work is to be inspected during progress and at completion.
e Restoration to be in accordance with City Code.
0 Street to be kept clean at all times.
9 Traffic Control to be in accordance with City regulations.
A 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 �lye _jo�_site for insvection purposes at all times.
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Signature: I 42*404A�'�_ Date: 1OZ4/88
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 \3 0 —days.
Special Conditions:
Amendments:
PERMIT FEE:
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
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FIELD INSPECTION NOTES (Fund I I I Route copy to Street De-p-t.)
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
PIN L APPROVAL BY: Date:
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APPLI ITION
for
The City of Edmonds 01HEET FILE SIDE SEWER PERMIT
U-"T) -t4p OUTSIDE 0 INSIDE El REPAIRS 0
OWNER ............ . ......... CA'."-5 ................................. ... CONTRACTOR ............
....................
- 0. STREET
HOUSE No. ........ 11-.:��A V-r..�15Z. -
.... ......... I ................ . ..... ........... ) ................................... AVENUE LOT No.
CARD No . .......
.......................... I ........
EASEMENT No . ............................................
.......... ...... PERMIT N' ,
0 .. .... ....
I -IT nd'V XT
....................... ...................................................... 0 . ............................. ..............................
al2-08 - 96-rAl Ale - ufll NAME ADD
" PPROVED
�MA Rf V 9 1% 2
Date 0
Approved:
'��ACKFILL WORK ORDER ISSUED .............................. ............. DEPOSIT, .................
a',,,WER WORK ORDER ISSUED .................................. ............. DATE..4��x,-
— ......... BY ... ............
DEPI.
NOTICE:
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N'o
The-infor . mation'shown on the attached
map(s) was com.piled for use by the OtY O�
Edmonds/ its Empl-oyees and Consultants.
nt the
Th,e City of Edmonds does. not. warra
accuracy of anything set for.th on t ' hese
Map(s). An . V person or entit,y -requesting a
copy -should conduct an independent
arding the infoirm'atlon shown, c
Inquiry reg
-Map(s), including, but not limited to,
-er stub shown. Su(
the lo�ation of any sew
sewer stubs may or may- not e-xlst and ma\
or may not exist at the location shown.
,�jty of Edmbnrls nor its
Neltheir the
ice,rs'sha-H be a-b-1--e for th
emptoyee-s o- off
information given on th�s map(5)) nor for
e.ntation provided based
anyone repres
upon said. m a p