22415 73RD PL W.PDF111111111111
5836
22415 73RD PL W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: �Nh'.I�t!09�7;Wrd R1 W
B. Type of Work (be specific): Replace�' 3 depreciated poles
C. Contractor: Snohomiih County PUD No. I
Mailing Address: po BOX, 3jQ7 Uierett hlAeh
State License #: . 98206
D. Building Permit # (if applicable):
Contact: Jerry EWDgton
Phone: 347 4414
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
F (P WN AB
F1 commercial []Subdivision E] City Project XG Utility UD, GTE, G, C LE, WATER
E] Multi -Family E] Single Family [] Other
INSPECTOR: 114SPECTOR:
F. Pavement or Concrete Cut: 0 Yes XQVo G. Size of Cut: x t;nargiE�>_
APPLICANT TO, READ AND�$J
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any 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 ofany legal proceedings including defense Costs, and attorney fees by reason ofgranting thispermit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND . MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CIT_YFORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing 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 ditches shall be patched with asphalt or City approved material'brior to the end of the working day;
NO EXCEPTIONS.
I have read . the above statements and understand thepermit requirements and thepink copy of thepermit will be
available o iteat all times fo i�rio.n purposes.
Signatu �91 or Agent) Date: ovemher A. 3996
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
7,T^ 1[17r%10Tr QTJ AT T IRVV-TW 'PPTnT? Tn PFRMIT 19SUANCE
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APPLICATION
for
CARD No . ......................................
The City of EclimonclsVnEET.
RLE SEDE SEWER PERMT
OUTSIDE
INSIDE REPAIRS E]
t,eASEMENT No - --------------------------------------
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OWNER ....... F ....... ............................. CONTRACTOR ........ 5.4kt--01 .. !:!,!� .................................................. .............. PERMIT No.
STREET _;�k '�))
HOUSN No. ........ w ............................... AVENUE LOT No . ...................... ----------------------------------------- BLOCK No . ......... 160.,...
..........
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NAME ADD. -------------------------------------------------------
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Date
BACKPILL WORK ORDER ISSUED ............................
SEWER WORK ORDER ISSUED ...................... ..............
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Approved:
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144.
DEPOSIT, $ ................. ...........................
DATE
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