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22830 106TH PL W
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Cit" Y of Edmonds
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RIGHT-OF-WAY CONSTRUCTION.
PERMIT Permit Number.qR-2-34
Lisue Date:
A. Address or Vicinity of Construction: 22830 - 106th P1. W
---Nnnmm� () Z B. Type of Work (be specific): GTE to plade''., operate, and maintain a - buried
17c. -,Is service wire from existina nedes-t-aI #A9 a i^r-at-a,4 9291 InA I W f-ha"
South to a residence at 22830 106 1 TJ r-TR to p1ow 231 1 Ax-14x-eway
and push I road 30 feet. R.O.W. footage is 132--fe-et.
Contractor: /-- �, i -- n Ct:T-InAn Pviop Pavmjt rnnvAinntnv
t
Mailing Address: 75 1 Z 141 E--:c 0 �(e7 OPhone: 425/710-4133
State License #: E fF'P- VJ A q '9 2 0 4 Liability Insurance: Bond: $
1400
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. 0 Commercial E] Subdivision E] City Project X] Utility (PUDCM WNG, CABLE, WATER)
EJ Multi -Family *] Single Family E] Other GTE��(4' i 2100-9P001DB9"*4b �I'iiv
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes No G. Size of Cut: x H. Chargq_$_
4,
APPLICANT TO READ AND Sldl�
INDEMNITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, 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 attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
v6N AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FJR ISSUANCE TO THE APPLICANT., ).
Two sets of construction drawings of proposed work reiluired 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 statemen a d u ers 7 epermit requirements and the pink copy of the'permit will be
available on site at all timesfo n ect r e
Signature: Date: 9-09-98
(Contractor or Ag t
David Squires Section Mgr.�-fkccess Design
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY. ptw
TIME AUTHORIZED: VOID AFTER DAYS
RIGHT OF WAY FEE: 1=60 - 0 0
DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: bla Ac4) eurS At-LoweQ RESTORATION FEE:
T'OTA-LFE.E;-
RECEIPT NO.:
r
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
FIELD INSPECTION NOTES (Filhd 111 -.Route copy to Street Dept.)
Comments:
-1 NO
CONTRACTOR CALLED FOR INSPECTION El YES E
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
I
L E., G E tJ D
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T SU8MITTED By
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PEDS V
POUES 0
ROAD SORrS
OVERHEAD UIN'-CS—
I.D. UTIUITY POTNOLE
UC TRC—'NC�iINl-.—JCT
vi
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FLAS'41"G GEACON SHALL BE i N,.,) I At
EACH SIC-N FOR NtGHT-T(MF- USE.
z, DISTANCES UAY VARY AS APPROVED 5-
ENCINEER.
3. FLACCERS REOUIRED TO CONTROL TRAF71;
WKENEVER THE CONTRACTOR MUST lNft�K,-
TRAFF I C FLOWIC ACCESS THE VORK < T L
WITH MATERIALS OR COMPMENTz
LEGMD-
Rl CONE OR CHANNELIZING DEVICE
(SEE STO 702)
WORK AREA
TRUCK W(TH
FLASHING OR WITH
BEACON t <
T50' MIN
zoo*
SHOUL
WORK fir 71 -5)
TRAFFIC CONTROL PLAN
SHOUMEM wow
t7od 882 *ON
10/26/98 10:28
NO. 908 1701
FAX MESSAGE
TO
DATE
— --I r- -..e
FROM TERRY ANDERSON
PHONE 425 771-8683
), �-q
SUBJECT Wo-;t— 6v;ovkk-
tc�r i, It fe—,;z -
COVER SHEET PLUS PAGES
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130 200
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City,of Edmonds'
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- 015
Issue Date: _197
A. Address or Vicinity of Construction:
189 0 B. Type of Work (be specific): �4&
14 J�kLD�A/0FJ=/_X1 EEW OF W47IR W/Q
&:;, C)
C. Contractor: OILYM V10 Contact: =)a� W/771QS�
,6� WAZ�P� -
Mailing Address: ;�-72�Ebmokns �& Phone: Z24 774e-)
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. [J Commercial E] Subdivision F1 City Project Kutility (PUD, GTE, WNG, CABLE, 10� �TEi
n Multi -Family [I Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut )oYes ONo G. Size of Cut: _1a;6 x 4 H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds 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 of any legalproceeding8 including defense costs, and attorney fees by reason of granting thispermit.
THE CONTRACTOR 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 CITY FORCES, AT WHICH TIMEA 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.
Wbrk 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. 'd by the City Engineer.
Traffic Control and Public Safety shall be in accordance with City regulations as require
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihavereadthea o I statementsa rstand the permit requirements and the pink copy of thepermitwillbe
ui� r /I 9,1_11 1/1, 5�ql'
available on site t 11 ti s to' in - * p rposes.
1A -- - - /1/7,07
Signature: YU /I I Ini I (AZA _PV/ Km It q
A A; Date:
e
wofkrac or or e
C DIA IG PRIOR TO BEGINNING WORK
FOR CITY USE.ONLY
APPROVED BY: wkz 4 C,4 RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS
DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: RESTORATION FEE:
4-10 � 0
PERMIT FEE:
TOTAL FEE:
COMMENTS: RECEIPT FE 0,:
fl
DATE; 'ISSUED BY-
rm
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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