22208 82ND PL W.PDF111111111111
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22208 82ND PL W
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City of Edmonds Permit No:oVO3— 05'
RIGHT-OF-WAY iCONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: Z_
B. Type o Work (be specific): 0 1� tVj��c, 1"I Ll I'-- T P 6 CJL 1:1
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C. Contractor:
Mailing Address:
State License 4-1 C__ k" H,
D. Building Permit # (if applicable
E.
F� Commercial El Subdivision
Fj Multi -Family Single.Family
INSPECTOR:
F. PAVEMENT CUT: YES NO
CONCRETE CUT: YES NO
NINDEMNITY: Applicant understands by hislN�sig�
"injuries, damages or claims of any kind or descr^Zn
Edmonds or any of its departments or employees, inclult
c4sts and attorneyfees by reason ofgranting this permit.
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\ OA U_�LK o A Co act: k k 0 1-114 CA. I Q L-1 f
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Phone:
Liability Insurance: - Bond:
Side Sewer Permit # (if applicable
E] City Project R EUC (PUE,
El OVW-r__� .00
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� h' application,,hks�he holds -the City of Edmonds. harmless ftom
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e1rf;o1reseen,or unforeseen, that may be made against the City of
not limit ense of any legal proceedings including defense
�ted to the def
CONTRACTOR'IS RESPONSIBLE FOR WORKMA;S ANR MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
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INSPECTION AND ACCEPTANCE. OF THE WORK. ESI ED R STORA TION FEES W7LL BE HELD UNTIL THE FINAL STREET PATCH IS
OR I
COMPLETED BY CITY FORCES, AT WHICH,TIMEA DEB OR CREDIT RUL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic control and public.safety shall e.in accordance with City regulations as required by the City Engineer. Every,,
flagger must be trained as require 'y- (WAC) 296-85-305 and must have certification verifying completion of the,
�y
required training in their possessip
Restoration is to be in accorda e with City codes. All street -cut trench work shall -be patched with asphalt or City -
approved material prior to the d of the workday — NO EXCEPTIONS.
Three sets of construction dra, ings of proposed work are required with the permit application.
CALL D L-A-DIG (1-800-424-5555) PRIOR TO BEGINNNG WORK
IHAVEREADTHEABO STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
'Date: �nlo) 63
Signature: 1�
(Contractor or Agent)
FOR CITY USE, ONLY.
Approved by, Right-of-way Fee:
Time A ' uthoriied: Void After Disruption Feefflund,1111:
Special Conditions: Restoration Fee:
Total Fee:
Receipt No:.
Issued by:
_4
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)'
FINAL APPROVAL OF PERMITTED WORK., DATE:
'40e Inspector's Signature
For inSDection
see
Information handout.
NO W011K SHALL BEGIN NZ1011 TO I'EIZMIT ISSUANCE
DAMy Documents\Forms\Engnmg\ROWpermit—.doc