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CITY OF EDMONDS _L2 4- �/ r*
Permit No.
CO1f4MUNITY SERVICES DEPARTMENT
RlGkT'-OF-'.WAY CONSTRUCTION P , ERMIT Issue Dat . e-- 26
a Cor r1l r-
A. 9 Owner:' ' Washington Natural, Gas C.OMPUY B. e Contrac . tor: '
Name
Ngff Mercer*',Street
Mailing Address Mailing Address
Seattle WA 98111
City State Zip City State Zip
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 40i 12 Avenue North
T . ype of Work to be Done: In I stall NEw Service
D. 0 Work in Connection With: El. Sub or Plat El. Sing!e, Family City Projects
El Commercial El Multifamily XX Utility
E. 0 Pavement Cut: Y N F 0 Size of Cut: 2 41 (1) @ Gas
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his §ignature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be ma . de against the City *of Edmonds, or Any of its 4epartmCnts or eipployees, including -or, not limited to the defense
of any. legal proceedings including defense costs, cov e y-rei.9on of granting this permit.
"V t n'd attorp y-f es
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,iss,uance to the applicant.
• A 2.4 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.
0 1 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature. Date:November 2, 1990
Owner or Contractor
This Perihit Must be Postedat the Job Site For Inspection Purposes
Call DIAL -A -DIG, Prior to Beginning Work
APPROVED BY: BW
Time Authorized: Void after FEIS
Special Conditions:
PERMIT FEE: .-�30—_eto—,Lo
Restoration Fee:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions:
INSPECTED B)
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
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FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street De
%pt.)
CONTRACTOR CALLED FOR INSPECTION E] YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588 (9 A
M
C—'� I S-r I t-4 C=t -L
PFOPOf'SED
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KEY:
-as- sanitary sewer
-s- storms
-w- water
0 water valve
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