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23813 107TH PL W
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City of Edmon&
RIGHT'OF-WAY CONSTRUCTION
PERMIT Permit Number. 42:7-z4l
Lssue Date:
A. Address or Vicinity of Construction: 23813 107th PI . tI.
-1-100now- ci B. Type of Work (be specific): GTE to pl ace, operate & mai ntai n a buri ed servi ce wi re f rom
'0c._'-J.S9 existing pedestal #3420, located across the street from 23813 107 Pl. 11., then east to aresidence at,
23813 107 Pl. W. GTE to plow 10 feet,.push no drivoways, and push one Fead 45 feet'K.U.W. footap is 55 ft.
Contractor: GTE NORTMEST INCORPORATED Contact: Linda Price, Permit eoordinator 425/710-4133
MailingAddress: 2312C U. Casino Rd... Everett WA Phone: ENGR: Terry Anderson 425/774-8683
!OUZ04-144U
State License #: Liability I=rance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. FJ Commercial F GTE WNG, CABLE, WATER)
Subdivision F1 City Project [5d Utility (PUD,E0
n Multi -Family SingleFamily Other
<:� - 11 9')
GTE VOIK-2150 9POOlDB 2421.10
INSPECTOR: INSPECTOR:
r. iravement or q-oncrete %-ut [,a I C�s L_J 1'4 0 %J. .3 Lz U UL. A �_J
Please see attached print.
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessftom 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, includingor not linutedto the defense ofany legal proceedings including defense costs andattorneyfees hyreason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
___1T1ON 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 FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 trench work shall be patched with asphalt or qity approved. material prior to the end of the working day;
NO EXCEPTIONS. 'j
I have read the above statements and un,&,rstar
j& the permit requirements and the pink copy of the permit will be
available on site at all timeXqr ins
Signature: Adow Date: 01-05-99
(Contractor or Ajent)
Dave HavkAns, Section Manager, ccess Design
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY FEE:
'W— - V
TIME AUTHORIZED: VOID AFTER DISRUPTION FEE/FU`ND I H:
SPECIAL CONDITIONS:
RESTORATION FEE:
T OTAL FEE:
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram
m
CONTRACTOR CALLED FOR INSPECTION D YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PERMIT SUBMITTED BY
GTE
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PEDS 0
POLES 0
ROAD BORES Q
OVERHEAD LINES
1.0. UTILITY POTHOLE CD
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