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411 6TH AVE N
-OF EDMONDS ST Permit N . o'. -30
CITW 5
RE
COMMUNITY SERVICES DEPARTMENT ET 1:9
RIGHT-OF-WAY CONSTRUCTION PERMIT issue Date D
A. 6 Ownef: 61 0 k B. 0 Contractor:, P Q'0
Name Name
ct C_ kV-\l -Z-1 0%14 RWA cl!l
Mailing Address Mailing Address
C__0 M ON 0 5 vi-pt!6". CA 9�ozo. J_.��LNrj Vi OOD W Aeti edoa(*
City State Zip City State L zip.
-7
State License Number Telephone Number
C. *Address or Vicinity of �Construction: (0-r-K F� V bi
Type of Work to: be Done: RA--PLALC <-_*iS-r 1aAb oO.Dea. 46� PoLk- w vrvA i3(.=W 46� PoLL- A-1-ti-61
POLk. UW0ei0f4-rA &)EST 113 Ppop We f
D. Work in Connection With:' 0 Sub or Plat El Single Family-- 0 City Projects
O.'Utilit
0, Commercial POAu4ffam4yZ� CY0
Y.
E. Pavement Cut: C3,Y, .0 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'Edmionds
harmless from any injuries, darnages,:or claims of any kind or_,description whatsoever, fors6en or unforseen, that may
be made against the . C ' ity.of Edmonds, or any of its depar1qA�/QFjOaployees, InAirdfriVor Vtdimited'to the defense
of any legal proceedings including defense costs, court 66s'ts, and attorn'ey fees by reason of granting this permit.
J_ I i- cw
T14E CONTRACTOR- IS RESPONSIBLE FOR WORKMAN HIP. A'�D 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.i§ completed by City forces, at which time a debit or credit will be
processed for'issuance to the applicant.
9 A 24 hour notice is required for inspection; Please. call Engineering: 771-3202
e Work is to be inspected during progress.and at completion.
* Restoration to be inaccordance with City Code/�'5'�'
* Street to be kept clean atall times.
.9 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.
Signatur e: . ne:3,� D. a te:.
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:
Z Time Authorized: Void after days. Restoration Fee:
0
Special Conditions: Put) M E=-En RE!SFbM.Ab Receipt No.:
HA
-VF- CR V Fund I I I Fee:
�gtJAL Fbt-E "REMOVED" WITH 1W
MON-TH5 Street Cut Dimensions: $
- * *
U
W RELEASED BY�"-" Datel�%S_ INSPEC'TE'D BY Date
0
W. NO WORK TO BEGINTRIOR TO PERMIT ISSUANCE
Enj. Div.'March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Depti)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 11 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Jul