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City.ofEdmonds
RIGHT-OF-WAY CONSTRUCTION.
PERMIT
Permit Numlxr: 9
At F
Wtie Date:
V91
"AAk.0A%dd1're"ss or Vicinity of Construction: 'Otla? g =� 4t, 0
1,2 C. B. Typeof Work (be.,specific): A—:95nELIS/6P13 00
422111, E 0 Aa�4 4 V 55
Contact:
C. Contract r.
Mailing Address: (A) IdIA Phone: 5�/ 0
StateLicense#.: Liability Insurance:. Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. El Comme* ial . F ivision City Pro" t Util y . (PU , D GTE, WNG CA . BLE, WATER)
rc _1 Subdi i i Jec J�,
Multi -Family Single Family F] Other
INSPECTOR: �0 SAA 4L INSPECTOR:
F. Pavement or Concrete Cut.: D Yes 0 G. Size of Cut: x H.' Chargt�_$
APPLICANT TO READ AND. SIGN
P.
INDEMNITY. Applicant understands and by his signature to this application to hold the City of Ednionds harmlessftom injuries, damagesi or claims ofany
kind or description whatsoever, foreseen or unforeseen, that may be made aga-14st the City of. Edmonds, or any of its departments or
employees, includingor not limitedto the defense ofany legal proceedings including defense costs and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS-F61? A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION A ND A CCEP TA AICE O� THE WORK. ESTIMA TED RESTORA TION FEES WIL L BE HE L D UN TH THE FINA L STREET PA TCH IS COMPLE TED
'BY CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICA NT.
Two sets of construction drawings of proposed work required with permit application.
A 24- hour notice is required for inspection. Please call the Engineering Division, 771-0220�.m
Work and material is to be inspected during progress and at completion.'
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public.Safety shall be in accordance with City regulations a:s required by the CityEngineer.
All §treetcuttrench work shall be patched with asphalt or City approved material p'ri-o'&,tothe end of the working day;. -
NO EXCEPTIONS.
I have read the above statements and understand the permit,re4uirements and the pink copy of the perm' irwill be
available on site at all timesfor inspection purposes.
D
Signature "AxZ4, ZZG� ate
(Cbiiitractorlor Agent),
CALL DIAL -A -DIG PRIOR TO BEGINNING,/.WORK
FOR CITY USE ONLY
APPROVED BY: lme L RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER 9 DAYS DISRUPTION FEFIFUND I 11:
SPECIAL CONDITIONS:Je(211k S 6 ou 14 RESTORATION FEE:
TOTALFEE:
RECEIPT NO.:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. iv 1997
FIELD INSPECTION- NOTES (Fund 111 Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION 0* V98" ONO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date: