215 OLYMPIC AVE.PDF11111111111111
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215 OLYMPIC AVE
CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT Issue Date 71 5i-
RIGHT - OF - WAY CONSTRUCTION PERMITSTFIEET FILE
A. eAddress or vicinity of Construction * Permit Issued To:
,)J-5 03_3PR�dr� Pl;* ?.� 1(91-67,4
• Owner: Wgh'AgtCA C-an Co * Type of Work to be Done: Zmk,-) I I Hsi? E-and ff-�
Name
naG; 156 e Work in Connection With:
Mailing Address El Sub or Plat Single Family
&_1 10himatm 90007 0 Comml. / Ind. El Apt. Condo.
City, S ta te, Zip Code 9 Pavement Cut: El Yes El No
• Contractor:— RUM 20 )*,Cylya
Name
Mailing Address State License Number
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< City, State, Zip Code Telephone Number
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0 L . NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
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B. APPLICANT TO, READ, AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
J4� from any 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 it's 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.
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Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
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Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Tra�ic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permiftjt be aailPle ati tWe job-42the for inspection purposes at all times.
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Owner or A -A*,"' I
*;k THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. lssue� By: i—
Time Authorized: Vold after —days
Spd'lal Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensions
X
* * -NO\WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Dir. 01 Pu);:,
Eng, Div. December 1978
FIELD INSPECTION NOTES (Fund 111 Route cony to Street Dept.)l
Di-agram:
Contractor called for inspection.. Yes No
T Date:
.47ork Disapproved By: -T)ate: Bv:
Work Approved Bv: Date: 'Jr1weA-1
Inspector:
Ena. Div. December -1978
n � Lo r3) 0 -D
EASEMENT NO - --------------------------------------------
218-01800 NEW CONSTRUCTION [] REPATRS [:] LID NO . .................. ASMT. NO . ..................
ag,7NlE-,q - ------- YVORT""N --------------------------------------------------- (CON'fRACTOR ------------------------------------------------------------------------------------ NO . ....... ------------
XN
703 A=2 SS ....... 21-5 ... QLY2 T 1 C AVE ----------------------------------- LEGAL DIESC-UP7"l-INT: LOT N10 . ...................................... BLOCX NO - ------------------------------------
........................................... .................................................................
NAME072 ADDITION .................................................. ...............
DYF TESTED ON SEWER
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Plt'YVV-CC31 - �'� /75 (.11 EV. I 1178) af."m ............................................ ny ............................................................