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404 12TH PL N
C.ITY OF EDMONDS
EN I G . INEERING DEP.ARTMENI' ftTREET FILE
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
(A=Z,-�cant to Co.-.-vZete A & B and Submt in DurZicate)
Pernit to be issued to:
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(DL
For work at: (address or vicinity) Anqz: I
Type of work t.o be.done:
,(Attach Drawing !,7hen Applicable)
Time Required� -- 0-tart: IZI� U E LLP
Owner:—ONID�K 06 mbvc
N
121r4 RL
Mailing Address
C-ify -State-
Contractor:
eat
MSiling Address
LYN Alwon W5�!�
city . . . I State
Finish: 12-12,
Telephone Number I I
State License Number
1- 1-16 OZ4--7
Telephone Number
B. INDEMNITY: Applicant understands'and by his signature to,�his application, agrees
to hold the City of Edmonds harmless from any injuries, damages or.claimi of any
kind or description 'whatsoever, foreseen or unforeseen, th ' at may be made against
,the applicant or the City'of Edmonds, or any of its departments or*employees,
including but 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 Department.
Work subject to inspection and restoration in accordance with City Code.
24-hour noticeis require&for inspection by the Engineering D4partment.
Call 775-2525.
A2
Signaturei
Wer'o� Agent'. Date Signed
DO NOT WR I TE BELOW TH I S L I NE (To be complete� by Issuing Agency)
Permit Issued (Date) �'� 7(0- Permit umbe-
2-45
Fee: Bond:
Time Authorized:
A
EER'S
M 173
The City of Edmonds
APPLICATION
for
SEDE SEWER PERMIT
NEW CONSTRUCTION [:I REPAIRS 0
I A
OWNER ........ /"Y. ....................................
mail -
ADDR=
1p a Ce iij a r
1*
or
IV6 1?7#
-- 12 ':f cf /��o
EASEMENT No . .............
aL* —
CONTRACTOR
------------------------------------------------- PERMIT NO.
LEGAL DESCRIPTION: LOT No . ..... .7 .............................. BLOCK No . .............................................
NAME OF ADDITION 4-/ ....... .......................................
Approved:
DATE .... V.7/J .. ... .......... BY
4#6
Al.