23526 78TH AVE W.PDF111111111111
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23526 78TH AVE W
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be lia-ble for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION CARD No . ......................................
for
The City of Edmonds STREET FILE SEDE SEWER PER3UT
OUTSIDE E) INSIDE E] REPAIRS C] EASEMENT No . ......................................
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OWNER . ...... ai� ..... J-6.1"
...... .... CONTRACTOR ................... ................................................... ...... PERMIT No(�
STREET
oe
HOUSE No. ----- ---- :72- AVENUE LOTNo. ./_0 ...... ....... y-_� ..... BLOCK No . ..................................... ........
NAMEADD . ............................................................................................................. - 1.
.................. ..........
IV IX
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Date A —roved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ................... .........................
SEWER WORK ORDER ISSUED ........................ ................. - ------ 13 y
---------------
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CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PER
ITREET FILE
A. *Address or vicinity of Construction
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0 Owner: -Ca
Name
J
Mailing Address
City, State, Zip Code
9 Permit Issued To
Type of Work to be Done:
T - . I �-� I
'ITew
Work in Connection With:
El Sub or Plat 0 Single Family
0 Comml. / Ind. El Apt. Condo.
Pavement Cut: 0 Yes El No
9 Contractor: --
Name
Mailing Address State License Number
Z
< City, State, Zip Code Telephone Number
U
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature 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 City of Edmonds, or any of it's 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.
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Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
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i-
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 accordance with Traffic
Section of City Code. Street ito be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit MUST"15c"Available a—t-TTL—ob site fj�&pection purposes at all times.
Signature:— -Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
Permit Fee:
C. Issued By:
> Time Authorized: Vold after —days Security Deposit:
Z Special Conditions: Receipt No.:
Fund I I I Fee:
Ammendments: Street Cut Dimensions
X
U.
NO WRRK,,TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 Route cony to Street Dept.
I
f*" --- - - 4� - .
Diagram:
Contractor called for inspection.- Yes NO
Work Disapproved By: Date: Bv: Date-..
Work Approved By: D a t e d
Inspector:
Enq. Div. December 1978