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222 3RD AVE S
CITY OF EDMONDS LARRY S. NAUGHTEN
2-50 - 5TH, AVE. N, - EDMONDS, VJ4. 98020 - (206) 77,-3202STREET ['*'�.'A �il MAYOR
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COMMUNITY SERVICES: PETER E. HAHN
Public Works a Planning * Parks and Recreation - Engineering DIRECTOR
- 8 9 0 - A 99
February 25, 1991
Ralph Sorensen
222 - 3rd Ave. South
Edmonds, WA 98020
Deal- Mr. Sorensen:
Due to the fact that the leak was caused by a meter gasket that needed
repair, I will allow a credit based on the use of water consumed last
year at this time.
Should you have any additional questions, please contact Ilene Larson,
Utility Billing Clerk.
Sincerely,
-0
Ron Holland
Water/Sewer Supervisor
RH/l k
cc: Ilene Larson
Utility Billing Clerk.
r '110575/TXTWATER
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jncorporol�-d A II-qos! I I S90
Sister Cities International — Hekinan, Japan
The City of Edmonds
APPLICATION
for
SEDE SEWER PERNaT
NEW CONSTRUCTION [-] REPAIRS [:] EASEMENT No . ..........................................
to I - ne-j �goQ
owNER....................... CONTRACTOR ........ ......................................................................................... PERMIT No . ......................
ADDREs s AVC . . ...... 5 .............................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
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NAMEOF ADDITION ..... ...................................................................................................................................
Jun a.,, jq7A
Dve- Tcsfed
Approved:
On Se-wer
DATE................................................ By ....................................................
A":
of Edmonds
RIGHT-O&WAY CONSTRUCTION.
PERMIT Permit Number.
Lssue Date: —
A. Address or Vicinity of Construction: 222 3rd Ave South
/17 B. Type of Work (be spec
C. Cont ractorClaambel r's Cable/Northsky
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Mailing Address: 190 W Dayton St
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StateLicense#: NORTHSC107JG
D. Building Permit # (if applicable):
ific):Road*bdre-under 3rd.S'. and -conduit
to 224 & 210 3rd Ave S
Contace-,76m Anderson
Phon� : 775-7504
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. [] Commercial E] Subdivision 0 City Projeck)UXUtility (PUD, GTE, VVW�� �LE ATER)
E] Multi -Family E] Single Family EJ Other
INSPECTOR: INSPECTOR:
J I %'J�: V, r I f't
F. Pavement or Concrete Cut 11 Yes ONo G. Size of CuF 2' x 10 H. &a - $_ '_ -
window ove,r,�-2eAiiities
APPLICANT TO READ XI�Df'91GN /5>
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, rclaims'ofany
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, includingor not limitedto the defense ofany legal proceedings including defense costs andattorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TIONAND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application,,
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in ac6brdance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
S_
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the workingday;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all time o inspection purposes.
Signature��I"".4
Date., cqh.--�- b?
—((-_onWa'TuTr`o`r Tgent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RQ
TIME AUTHORIZED: VOID AFTER APRIL 30+L-% DAYS
SPECIAL CONDITIONS: r=k9Y_b.F_ !_G1b9A4
RIGHT OF WAY FEE:
DISRYPTION FEENUND I 11:
RESf6R.ATION FEE:
T OTAL FEE:
RECEIPT NO.:
4
C,
ISSUEDBY:
NO WORK SH"ALL' BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
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