22224 98TH AVE W.PDF%-I
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9692
22224 98TH AVE W
-7
City of Edmonds
CONSTRUCTION
RIGHT-OF-WAY
PERMIT
Permit Number.
—C
Lssue Date: 6 7
A. Address or Vicinity of Construction: =2"22224B 98th "e W (0#107006740)'
B. Type of Work (be speci InstaiLl A—I-174' PE PJLPe Gas Main in__98D, Ave W;
in C.- fc): i6e im 0 100E ef the mmuwM line in-%th.Ave W
& N of the c/1 of 224th St SW; extend 9m m-un 240114 to gwrye cust.
C. Contractor: PUGET SO= EMGY Contact:* DOUG USITUD
Mailing Address: 1122 75th St SW Everett 9=:2hone: (425) 356-7520
State License #:
D. Building Permit # (if applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. El Commercial Subdivision City Proj �ct Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi-Faraily El Single Family _'b-Ither
INSPECTOR: INSPECTOR:
X_' en— 2 5 Tx r"1L---- 4,
r. ravement UU %-UnUICLU 'k-UL C;z' L-JI'lu
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom in�uries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, 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 and atiorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMA NSHIP A ND MA TERIA IS FOR A PERIOD OF ONE YEA R FO�LO WING, THE FINA L INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAr-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 accordance 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.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
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 times for inspection purposes.
Signature:
2 -
Date: 5/24/99
(Contracior or Agedt) OkM H L0pEZ_FUgU]LA0
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVE D I BY: LJ
TIME AUTHORIZED: VOID AFTER AL6 DAYS
SPECIAL CONDITIONS: A-
RIGHT OF WAY FEE:
DISRUPTION FEEIFLYND I 11:
RESTORATION FEE:
T OTAL FEE: ego
RECEIPT NO.: /_1
ISSUED BY_��
I - -+1 �, , I
FIELD INSPECTION NOTES
Comments:
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
SCALE: I"=50'
CQ
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22224
22224
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1. U A 1, 1,
2. CITY OF EDMONDS:
Maintain a minimum of 5' horizontal
and 3' vertical clearance from all
city utilities and appurtenances.
Cuts in paving are shown as
cuts in paving anticipated.
Notify Engineering Division 24 hrs
prior to construction - 425-771-0220
3. PROJECT MANAGER: DOUG USITALO 1-425-356-7520
TIE-IN a ____'N, 10'E IL
:(2 X 1-1/4" SVC. TEE)
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CQ
510,1
224 TH '0T SW
DESCRIPTION
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0 SERVE: 22224 & 22224 B
98 TH AVE. W
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