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21727 96TH AVE W
71 CITY40F EDMONDS . 01
COMMUNITY SERVICES DEPARTMENT
kIGHT-OF-WAY CONSTRUCTION PERMIT
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A. * Owner:
Washington Natural Gas -Company
Name
815 Mercer Street
Nigilipt Address
ea tle WA 98111
City State Zip
ILI: Permit No� Zk 0
Date
B. e Contractor:
Name
Mailifig Address
City State Zip
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 21728 96 Av enue West "N -1
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: El Sub or Plat 0 Single Family El City Projects
0 Commercial 0 Multifamily R) Utility
E. 0 Pavement Cut: El Y 9 N F..".4 Size of Cut: — X No cuts
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims1of any kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its,4 , ep , artrrients or employees, including or not limited to the defense
/ >r"
of any legal proceedings including defense cos 6ses`,qnd aetorn fee.sby reason of granting.this permit.
C f-Y
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.
e A 24 hour notice is required for inspection;.Plq�se call Engineering: 771-3202
• Work is to be inspected during progress afid 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 witA 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.
Signature:. McAa&��' Date:January 3. .1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY:
Time Authorized: Void after I \1 CA 2� days.
Special Conditions: SkaMA 7b iSEC-AFIVIF,
WF-V,) 'Vlb R AA A) P_ W10 aVEFJL�Ay. —
WOV-4 -ro
RELEASED BY:
Date
PERMIT FEE: 41
Restoration F
Receipt No
Fund I I I Fee:. —
Street Cut Dimensions:
INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
FA_
x —'W = $_
Date
Eng. Div.Warch 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Igeot.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
AUaenaum. to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
�/I . , --) 2-
- I I
)y 0
City Clerk Phone 775-2525 ILE
4, CITY of EDMONDS BLISI S LICENSE APPLICATION
DAT LICENSE NO.
CW1c Center Edmonds, Washin� R TYPE OF BUSINESS ANNUAL FEE
3t,
",980
ET F
CLASS! YEAR LIC. EFFEC. DATE REASG. LIC. NO. SPEC. A) HOME OCCUPATION . $15.00
1 �dl(
AFTER FEB. 15
$ 22.50
INSTRUCTIONS:
0 (e) BUSINESSWITH
$20.00 $ 30.00
• All items must be completed
RECEIPT NO
DATE PAID
1 TO 3 EMPLOYEES
or application will not be ac-
rV
PRINT'X'
IN
SPEC. BOX
C3 (C) BUSINESSWITH
$22.00 $ 33.00
cepted.
FOR
ISSUE OF
4 TO 9 EMPLOYEES
• Sign and return application
KEE PAID
PENALTY PAID
CORRECTED
LICENSE
'LC*
WITH
C3 (D) BUSINESS WITH 10
OR MORE EMPLOYEES
$75.00 $112.50
ACTION.
with fee. Renewals received
after February 15 must pay
NEW APPLICATION (LA)
?��
penalty in addition to fee.
RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(I-C)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
NAME OF FIRM
BUSINESS PHONE
EMPLOYEES
/A t, I. -� � /�Z- 7T- l-,1,A4 7-1&, /VS
77 / - `16 S-X
MAILING ADDRESS
NATURE OF BUSINESS
a Olz 7 i-z, 7, /,-., 61-)
(—, �- - --
;x
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
-1
J2� -j (S) (P)MAR 18 = (C)
0/,/,/ 7411 A,
OWNERS NAME HOME ADDRESS EDMONDS FIRE DEPT.
711/�/
HOMEPHONE DATE OF BIRTH 7PLACE OF BIRTH OCIAL SECURITY NUMBER
s—/ � / :2 -, �z 7 - :�s -6, 4 - -��2
EMERGENCY NOTIFICATION (1) NAME&TELEPHONE
7,7,(,
(PLEASE LIST TWO) (2) NAME& TELEPHON
75-22;
WASHINGTON STATE TAX NO6/,,-7/,1 APPLICANTSSIGNATURE,- -1-4 a- K" t-Uz -/
Z-
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR DISAPPROVAL, DATE, AND
SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION.
ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT
AP APPROVE C] DISAPPROVE DATE
LAND USE CODE ZONING CODE
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPARTMENT 4)
9-'APPROVE CI DISAPPROVE DATE
SIGNATURE H -
Building 0 Hotel/Motel
Permit 0 Apt. Bldg.
(L)
(A)
0 Office Bldg.
(0)
COMMENTS:
Occupancy 0 Restaurant
(R)
Group El Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
El School
(S)
FIRE DEPARTMENT DATE �1119-gz
U. F. 1. R.
AAPPROVE EJ DISAPPROVE SIGNATURE
-1141 101021
25 2
COMMENTS:
P96CE DEPARTMENT
APPROVE DATE SIGNATURE
V 0 DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
DATE
APPROVE El DISAPPROVE SIGNATURE
COMMENTS:
PI F=A.q!= PI=TIIPNI TO r.1TV r.1 I=Pk'