22024 76TH AVE W.PDF6352
22024 76TH AVE W
CITY OFIEDWV4DS Permit No. -7cf-216
PUBLIC WORKS'DEPARTMENT Issue Date A
RIGHT - OF - WAY CONSTRUCTION PERMI
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Owner: P:iV%K%,!JQU
Name V
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City, S ta te, Zip Code
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Contractor:
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City, State, Zip Code
0 Permit Issued To:
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• Type of Work to be Done: WideA Nrcuo&gaq
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• Work in Connection With:
D Sub or Plat 0 Single Family
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• Pavement Cut: El 0
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State License Number
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Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
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.
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.
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 permit must be avai I t the job site for inspection purposes at all times.
J
Signature: Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: V
Special Conditions: I
Ammendments:
Permit Fee: Is --
Security Deposit:
Receipt No.: —0 00cl 0
Fund ill Fee: A ) /P
Street Cut Dimensions
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* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978