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CITY OF EDMONDS a law
COMMUNITY SERINCES DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
Permit No.
Issue Date Z 7)
JUN 17 1888
A. Owner: LE L L E -F%AW9RRctorCe6X1rf?S=_Tr-
'Rame
Nam�q / 414 q5 t-t Amz—,W, 3�1119_ A"iwp�a Amr-, N,
Mailing Address
wn. qq,020 WQ� 1qP143
City St;ifeJ 'zip City --State Zip
State License Number Telephone Number
9 Address or Vicinity of Consti
Type of Work to be Done:—
/-? lov r'I's r& � — 4A ;a-
.1 U Po
Work in Connection With: '
Pavement Cut: E) Y n,,N
APPLICANT TO READ AND SIGN
Rt
Tsu5'oTl5lat" 'D31,Single Family 0 City Projects
0 Commercial 0 Multifamily El Utility
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 departments or employees, including or nol 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
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
t I
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.
• A 24 hour notice is required for inspection; Please call Public Works: 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.
Signatu
Z, , "A P " Ile hp,
Date:-Z
Owner- or"Contractor
This Permit Must Be Posted at the Job Site For Inspection' Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: ---I - 1 5 K�g'�z
Time Authorized: Void after —.days.
Special Conditions:
Amendments:
PERMIT FEE: 4-
Security Deposit:
Receipt No.: ��/
Fund I I I Fee:
Street Cut Dimensions:
X
'NO WORK TO'AkGIN -PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY
Date:
Date:
Eng. Div. July 1985
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION [:] REPAIRS EASEMENT No . ..........................................
111-07200
OV17NER .......... Vernon C. fluel ler
.................................................................................................... CONTRACTOR --------- ....... ................................................................................ PERMIT No . ......................
ADDRESS ...... Z1.41.4 ... . ... 951h..Ava.-Al ....................................
0
LEGAL DESCRIPTION: LOT No . ............................................. � BLOCK No . ............................................
NAME OF ADDITION
Dye Tested On Sevier 1972
Approved:
DATE................................................ By ......................................................................