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CITY OF EDMONDS
ENGINEERING * DEPARTMENT
505 BELL STREET
EDMONDS, WASHINGTON 98020
APPLICATION FOR INVASION OF RIGHT-OF-WAY
(Submit In Duplicate)
Permit t"o"b"isued to:
vicinity)
For work at: (address or
4 11 t, A z7-
ype o wor to e o e:
(Attach Drawing When Applicable)
Owner: . �, C-,-/ a -f\,\ E �-/
Name
Mailing Address
.3
city State Telephone Number
Contractor:
Name
Mailing Address
City State Telephone Number
Owner or Agent
Ire,
Date Signed
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (date)- /7 Permit Number 7 /SI
Remarks: &4110
Upon issuance of this permit, the contractor is responsible
for workmanship and materials for a period of one year
following inspection of the restoration by the Engineering
Dept.
6 Work subject to inspection and restoration in accordence
with city code. A 24 hour notice is required for inspection.
Call 775-2525