215 & 217 4TH AVE N.PDFIIIIIIIIIIIIII
14629
217 4TH AVE N
STREET FILE APPLICATION
for
Tho City of Ed"nds 8MV azWlm Pznmrr
EASEMFJM No . ..........................................
NEW CON WCTION REPAIRS
114-00650
OWNER ........... I�A:!IK�y .. �j ........ h i.c.k. s ...................................................... CON'TRACTOR ..............................................
...... .. .. ... ............. ...................................... PER)= No . ......................
AiDDREss ....... 217 .... 4.th...Av-e-. .... at .................................................... IEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
N
NAME OF ADDITION .........................................
Dye Tested On Sewer 1972
ApprovW:
DATE..... .......................................... W ...............................
City -of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. e?41—
Wue Date:
A. Address or Vicinity of Construction: 215 & 2`13, 4 Ay (9428793 & 94287A)
9 C� B. Type of Work (be specific): Install New Service
0 19
C. Contractor. Wa§hington Nattiral ra
Mailing Address: 815 Mercer S t P *SP-a t __WA
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frjank SWnn
Phone: 794-9?7g
Liability Ins:urance: Bond: $
Side Sewer Permit # (if applicable):
E. (:] Commercial []Subdivision 0 City Project [E Utility (PUD, GTE, WNG, CABLE, WATER)
C] Multi -Family [] Single Family 0 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes QNo G. Size of Cut: x H. Chargq_$
APPLICANT TO READ AND -SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hollinj eiiy of Edmonds harmli.. fr."
minjurie ages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agaipht the City of Fdmondg, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs,'and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS'RESPONSIBLE FOR WORKMANSHIP AND MATERIALS f9R A-fERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION VEE� WILABE HELD UNTIL Tf1EA41'#A_P-SrftWT PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with pen -nit 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.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand the permit requirements andthepink copyof thepermit willbe
available on site at all times. r inspection purposes.
Ifo
Signature: Date: Simpt-pmher 15 1994
(i�6n'tr�ctor*or,,(de"n-i)''I"'.'..
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY I
APPROVED BY,: AWRITWI-7
T . IME AUTHO.RiZED: VOID AFTER F-A IL DAYS
SP ECIAL "CONDITIONS:
COMMENTS:
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991