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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERNOTREET F
A. *Address or vicinity of Construction
24110 77 P1 West Plat 167-069.001
9 Owner: Washinctm Natural Gas' Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 98007
city, S ta te, Zip Code
0 Contractor: Scme As Above
Name
Mailing Address
City, State, Zip Code
Fermit No.
Issue Date
0 Permit Issued To:
0 Type of Work to be Done: InStall New Service
0 Work in Connection With-
0 Sub or Plat �� Single Family
0 Comml. / Ind. El Apt. Condo.
0 Pavement Cut: El Yes 0 No
State License Number
Telephone Number
* * 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.
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.
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 to 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
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Signature:
Owner or
t be av30able he
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for inspection purposes at all times.
Date Aug 6, 1980
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: I / _/ !0
Time Authorized: Vold after 1"00 —days
Special Conditions:
Ammendments:
Permit Fee: -_661 ,
Security Deposit: Z51
Receipt No.:
Fund ill Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. Dumber 1978
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 liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
A '-Atib
for
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HOUSE No ...... a. ......................... 'AVEN Y. 13 CK No. ....................................... . ..
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BACKFILL WORK ORDER ISSUED .......................... ........ DEPOSIT, $ ........... 1 ...................................
QRWER WORK -ORDER ISSUED ..... ............................ ....... DA:].:� By