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MEMO TO:
CITY OF EDMONDS
121 5TH AVENUE NORTH * EDMONDS, WA 98020 - 425-771-0220 - FAX 425-771-0221
Website: www.cLedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Edmonds School District
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
Please be advised of the corrected addresses (see attached):
GARY HAAKENSON
MAYOR
Tax ID Number: 00434400200300 Addressed as 211 5 1h Ave N
00637200000100 — 00637200000400 Addressed as 217 5h Ave N
00637200000400 Addressed as 223 — 229 5th Ave N
If you have any questions regarding this letter, please contact a City of Edmonds Permit Coordinator at
425-771-0220. Please contact our office if you wish to be removed from future address change
notifications.
Y,
eresa mbaiu4igh�
Senior Permit Coordinator
Edmonds Building Department
L\Temp\]DST's\Master Letters\New Address7/6/2010
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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Permit No:
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: co
A. Address or Vicinity of Construction:
B. Type of Work (be specific): 10 L) e' C'-'k-q"k �W�
C. Contractor:
Mailing Address:
StateLicense#:
Contact: L'/<Z_ 6�1 1 A14
Phone:—'-/2 S_ _2 ? y 3 1
Liability Insurance: Bond: $
D. Building Permit # (if applicable): 74�� Side Sewer Permit # (if applicable):
E. City Project EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Commercial Subdivision
Multi -Family E] SingleFamily r7 Oflier
INSPECTOR.
F. PAVEMENT: F� YES F1 NO G. SIZE OF CUT x H. Charge:
CONCRETE CUT: YES NO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Ed monds harmlessfrom injuries,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting 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, ESTIMATED RESTORATION. FEES 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.
* Traffic control and public safety shall be in accordance with City. regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO. EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
I THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
'#,I Signature:
Date:
or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK.
e"L_ FOR CITY USE ONLY
Approved by,__WT__M h-uk Right-of-way Fee: WA I\/ J-7—b
Time Authorl�z__e �:VoidAfter i;w/ 670 Disruption Fee/Fund 111:
Special Conditions: S kQT--_1AA L"estoration Fee:
C)F:: Total Fee:
Receipt No:
Issued byf:-)�M Y14 A
UPON COMPLETION OF PERMITTED WORK- AN ENGINEERING. FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
RX
FINAL APPROVAL, OF PERMITTED WO
"�-S&6TORS SIGNATURE DATE:
For inspection requirements, see Engineering Information Handout.