421 10TH AVE S.PDF111111 lill
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421 1 OTH AVE S
CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT STRLZET FILE
A. oAddress or vicinity of Construction
421 10 AV S Plat # 163-067YO02
0 Owner: %2Shingtm Natural Gas Co
Name
805 156 AV NE
Mailing Address
B611sxme�nTftlashingtcn 98007
city, S ta te, Zip Code
Contractor: qam-- A Abowe
Name
0 Permit Issued To:
• Type of Work to be Done: install Naw Ssrvic�
• Work in Connection With:
0 Sub or Plat .91 Single Family
El Comml. / Ind. 0 Apt. Condo.
0 Pavement Cut: 0 Yes El No
Mailing,Address, State License Number
Z
City, State, Zip Code Telephone Number
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Q. 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 1�! costs, court costs, and attorney fees by reason of granting this permit.
0
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W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
co following the final inspection and acceptance of the restoration by the Engineering Division.
0
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0
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 permit mVe,,available at the o sAiter inspection pqrposes at all times.
I
S ignature:—
— — — Date Nov IL 198r
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C,-t 1'�Atqd -1 � /
By 40
Time Authorized: Void after days
p ci 0
e al�C n itions:
A ' , ,
mmendmeints:
Permit Fee:
Security Deposit: /7
Receipt No.:
Fund 111 Fee:
ECEIV&iDet Cut Dimensions
X
�l 0 y (�) 19 81
NO,,WORK\TO BEGIN lPk "'PtRMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund. 111 - Route conv to Street Dent.
rf-IMMM"* C -
Diagram:
ItIECMVED
NOV 181990
Dir. Of Public Works
Contractor called for inspection Yes No
Work Disa.T.3proved By: Date-. Bv: Date:
Work Aporoved Bv: Date:
Inspector:
Encr. Div. December -1978
APPLICATION
10
for
The City of Edmonds
SEDE SEWER PERMIT
NEW CONSTRUCTION El REPAIRS E:] EASEMENT No . ..........................................
108-07500
OWNER............ ......... ........................................................ CONTRACTOR .................. ............................................................................. - PERMIT No . ......................
ADDRESS ........ 42-1 --- - --- TGth ... A-ve,,.--S . ................................ ................
0
LEGAL DESCRIPTION: LOT No . ...... --------------------------------------- BLOCK No . ............................................
NAME OF ADDITION
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................