22304 76TH AVE W.PDF111111111111
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22304 76TH AVE W
CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT Issue Date 7
RIGHT - OF - WAY CONSTRUCTION PERMIT
STREET HU:
A. *Address or vicinity of Construction Permit Issued To:
22304 76th Aim. W. , Edmnds
0 Owner: Craneral Telephone Co. of N.W '6 Type of Work to be Done: Place overhead cable
Name Attentiow. J. StoJkovic for now riser. Ssa attached priin .
P.O. Box 5124, Work in Connection With:
Mailing Ad dress 9 Sub or Plat El Single Family
1�rnnwood, WA 96036-0870 0 Comml. / Ind. El Apt. Condo.
City, State, Zip Code e Pavement Cut: El Yes No
o Contractor: 9anTP '2100-2811082 C302
Name
Mailing Address State License Number
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1� City, State, Zip Code Telephone Number
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NO WORK TO.BEGIN PRIOR TO PERMIT ISSUANCE.
B. APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
tw from any injuries, damages, or claims of any kind or description whawever, foreseen or unforeseen, that may be made
against the City of Edmonds, of any of its departments or employees, including or not limited to the defense of any legal
04 proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
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U Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
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co following the final inspection and acceptance of the restoration by the Engineering Division.
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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 accordan ce 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.
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I understand that this permit must be avail,�ble at�t e o? site for inspection p"u'rposes at all times.
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Signature: X" 61301m-
-"Z, a /Zol /11� Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
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ssuccl By; Permit Fee: !611�
L days
Jime Authorized: Vold after
Special Conditions:
Ammendments:
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
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* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route cony to Street Dent.
Comments:
Diagram:
Contractor called for inspection Yes NO
I Date:
�Alork DisaT.?proved By: Date:
Work Approved Bv: —Date
Inspector:
Ena. Div. December 1978
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WO`2100-2911082
C. 450 2.
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