221 3RD AVE S.pdf41
CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 9 Owrier: Washington NAtural Gas
Ngg 156 AV.NE.
NWjnf:e4Marcss WA 98007
City State Zip
B. a Contractor Same
Name
State License
e Address or Vicinity of Construction: 221 3 Av.S.
Type of Work to be Done: New :instal
Mailing Address
City State Zip
447-0700
)er Telephone Number
Work in Connection With: El Sub or Plat 0 Single Family 0 City Projects
I— El Commercial 0 Multifamily [N utility
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< Pavement Cut: El Y 0 N
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APPLICANT TO READ AND SIGN
P-4
PLO
-< INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
>-4 harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OFTHE WORK.
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U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit �vill be processed for issuance �o the applicant.
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* A 24 hour notice is required for inspection; Please call Public Works: 771-3202
* Work is to be inspected during progress and 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 with asphalt or City approved mzterial prior to end of working day;
no exceptions.
I understand the above and that this pern
git ust be available at the job site for inspection purposes at all times.
12-14-87
Signature: Date:
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Be2innWE Work
ISSUED BY: A'141LIZ PERMIT FE
Z Time Authorized: Void after -367 —days. Security Der osit:
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W Special Conditions: Receipt No.:
Fund I I I Fee:
Amendments: Street Cut Dimensions:
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pe. X
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V-4 NO WORK TO BEGIN PRIOR TO PERMir ISSUANCE
Eng. Div. July 1985
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