21824 96TH AVE W (2).PDF111111111111
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21824 96TH AVE W
CITY OF EDMONDS 4w, — U I
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
Wermit No. 0
Issue Date
1980 ul" �
-1
A. *Address or vicinitv of Construction Dir. Of Tublirs�Iopamit Issued To:
21824 96 AV W 164-067,006
Owner: Washingt2n Natural Gas Co.
Name
805 156 Av NE
Mailing Address
Bellevue, Wa. 98007
city, S ta te, Zip Code
0 Contractor:
Name
Same as Above
• Type of Work to be Done:
Install new service
• Work in Connection With:
E] Sub or Plat El Single Family
El Comml. / Ind. El Apt. Condo.
• Pavement Cut: El Yes El No
Mailing Address State License Number
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< City, State, Zip Code Telephone Number
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NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: 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, 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
co 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 Traffic
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 perpt roust be available at the j-1- site for inspection purposes at all times.
Signature: ate —
Owner or AaEnt
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By.
Time Authorized: Vold after --?-a days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
� X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978