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CJ&Y OF EDMONDS No\.) a
"%MUNITY SERVICES DEPARTMENT
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RIGHT-OF-WAY CONSTRUCTION PERMIT 00 C.TS
A. e Owner: Washington Natural Ga Contractor:
Name
815 Mercer Street !Art
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City Stite"—' Zip
Permit No. C70 - Y
Issue Date /o / 9
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 24219 78 Place West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: El Sub or Plat 0 Single Family El City Projects
0 Commercial El Multifamily Utility
E. 0 Paverneilt Cut: D Y KI N F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless'ftom any injuries, damages, or claims of any kind orAescription whatsoever forseen or unforseen, that may
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be made against the City of Edmonds, or any of its depa fi' 'e*oyee�,cjncIu(firrg oinot limited to the defense
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of any legal proceedings including defense costs, court cost, X2d �a'orney fees by reason of granting this peqmit.
1 1, 1 1 1 -
THE CONTRACTOR IS RESPONSIBLE FOR WORKM�NSHIP AND N4AT�ERIALS 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.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: m6m"t"_'� Date: October 4, 1990
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: PERMIT FEE: 4'
Time Authorized: Void after DCC- 30 days. Restoration Fee:
Special Conditions:
RELEASED BY:
Receipt No.: —
Fund I I I Fee:
Street Cut Dimensions: — x — = $
Date Iff - d - 0 INSPECTED BY
F r
Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street Depp.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
Addendum to:
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City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
- I eAS AAAI&4
KEY:
-ss- sanitary sewer
-s- storms
w- water
0 water valve
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