22424 77TH AVE W.PDFIIIIIIIIIIII
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22424 77TH AVE W
CITY OF EDMONDS
PU*C;*KS DEPARTMENT., ENGIN010,DIVISION
APPLICATION FOR RIGHT-OF-11AY CONSTRUCTION PER . MIT
THIS PERMIT MUST BE A . VAILABLE AT THE JOB.SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A.' Permit to be issued "It-o'': LA
For Work at:(address or vicinity)_._
70 a C_ S
Type of Work to be done: 1-rz u-s,) C oQ f Li
(Attach drawing when.applicable)
Time Required Start: Finish:
Owner:IP- Q -)A� C_ 0 tA IJ'-)(
e
Mailing Address-
L-e�jQwovv�> qkP34, )24 cd—J)
City State Zip —Telephone Number/.
Contractor:
Name
Mailing Address
State License Number
City State Zip Telephone Number
B. INDEMNITY: Applicant understands and.by his signaturdi, to this application, agrees.
to hold the City of Edmonds harmless. -from any injuries, damages, or claims of any
.kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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, court costs,, and attorney fees.by reason of granting this permit.
Xpon issuance -of .,this permit�,, the contractor is responsible,for workmanship.and
materials'for a period'o - f one year following the.final inspection a"nd.accep tance
of the red'toration by the*Engine* rf g Division
e in
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 subject to inspection and restoration in accor I dance with City Code. A
24-hour n otice is required for inspection by Engineering. Call 775-2525, ext. 220.
Iunderstand that this permi st be available at the job site for inspection
purposes at all times.-
Signat /re:
Date:
Owner or Agent
C. TO BE COMPLETED BY IZSUING AGENCY
Date Issued: A,
Permit No'. :,7
Fee - At -
Security Bond: _y. 47
Time Authorized:
APPROVED B Date:
10-7711, 1