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24109 106TH PL W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number- 17- 7
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Issue Date:
A. Address or Vicinity of Construction: 24109a106 PL Q (9708657).:'
4
9 0
B. Type of Work (be specific): Install 2301 of 2"MPE IP Main from 140'N to-
240'N C/L 242 Pl SW @ 14'W C/L 106 P1 W offset here to 18'W C/L
Pl W run North to 3551N Cit 2242Pt SW
C. Contractor: _Wng now Puget Sound Energy Contact: Marianne Kingsbury
MailingAddress: 1122 75 St SW Eve�ett Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. 0 Commercial [:] Subdivision El City Project (2) Utility (PUD, GTE, ArNG, CABLE, WATER)
n Multi -Family El Single Family E] Other
INSPECTOR: 114SPECTOR:
F. Pavement or Concrete Cut Yes []No G. Size of Cut: ZAA 4 0.11 �6�_IrL
APPLICANT TO R",V/jkND SIGN
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 defe I nse ofany legalproceedings including defense costs, and attorney fees by reason ofgranting 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 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.
T�raffic 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 prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposes.
Signature: Date:
,,-I_(Colltractoror"Agent)�_ � .
APPROVED BY:
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
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FOR CITY USE ONLY
TIME AUTHORIZED: VOID AFTER DAYS
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SPECIAL CONDITIONS:
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COMMENTS: 'e_- V,'�
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: 0
RECEIPT FEE: ( I I
DATE:
ISSUED
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
FEUMF
Notes: The City of Edmonds
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1 Field locate all utilities.
Call 1-800-424-5555'
24 hours before digging.
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Notes: The City of Edmonds
L'J kA P I C- \J I C--,-, WTQ / -5c,"
Field locate all utilities.
Call 1-800-424-5555'
24 hours before digging.