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The City of Edmomb
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APPUCATION
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CARD No. _ .............. ........... . ......
EASEMENT No . .................... _ .... . ..
CONTRACTOR .............. .......... .................................. ..PERMIT No -
STREET
.......... AVENUE LOT No . ........................................... ................... .............. BLOCK No . ...... ............ .................. ......
NAME ADD -Rare All that por of Gov Lot 2 in See 24, T27N,0 R3E.,
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WOM*jp dese as fol: Commencing at the intersection oT'S ��kgin
of County Rd v&th Easterly margin of 3rd Ave;'th Southwesterly
alg sd Easterly margin of 3rd Ave for 890.001,, more or less,,
to the NVI cor of Tr Described -in Deed recorded in -
Vol 281 of Deeds on pg 493., record of Sno. Co.,,
4z Wash,, sd point being the TPB of the Tr of
land herein described? th E to W margin
of 6th Ave; th N 801; th W to E margin of
3rd Ave; th Southwesterly to TPB.;
EXCEPT 19he E 1001 thereof,
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APPROVEO
Date Approved: JU'V V IN2
13ACKPILL WORK ORDER ISSUED ......... ............. .................... DEPOSIT, ............. .......... ............ ....... ------------- -
SEWER WORK ORDER ISSUED .................................... _ .......... DATE. 1 ............... BY
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PUGET
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Order#: /060 a -1551
Notif#: 300101�)34,
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Addendum To: . Citv of Edmonds
Right Of Way
Permit Application
Submitted by: Craig Simpson
New Customer Construction
Puget Sound Energy
425-356-7500 ext. 7571
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City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTIO�' PEPILMIT Issue Date: 9-1-7-9.9
A. Address or Vicinity of Construction: 524 3 AV8 N, EDMONDS
B. Type of Work (be specific): 1 EMMER WATER PAVING 39' WATER 51 OFF WEST. EDGE (#106034594)
C. Contractor: PUGET SOUND ENERGY Contact: DOUG USITALO
Mailing Address:' 11682 75TH SW, EVERETT/ MO# Phone: (425) 356-7520
State License #: rl�iAbility Insurance: �Bond: $
J�
D. Building Permit # (if applicable): Side Sewer Per"mit # (if applicable):
E. F1 Commercial SAilivision City Project n EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
F-I Multi -Family F] Single Family Other
INSPECTOR-
F. PAVEMENT: YES F 2 x 5 H. Charge:$
z _] NO G. SIZE OF CUT
CONCRETE CUT: YES F1 NO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description vAatsoever, foreseen or unforeseen, that may be made against 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 and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS 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 IS
11�
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT._
* Traffic control and publi� safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be traine d as required by (WAC) 296-455-30.5. and must have certification verifying completio . n of the
required training in-theirpossession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphal(or City�
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit'application.
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: FELKA H. LOPEZ—FUGUIA0 Date. ... 4)/8/1999
(.Contractor or Agent)
CALL DIAL-A-DIG.(1-800-424-5555) PRIOR T0,13EGIN.NING WORK
FOR CITY USE ONL7
'7o"'--
Approved by: Right-of-way Fee:
Time Authorizid: - �',.Voi&After WV �30 1 '95 Disruption, 'Fee/Fund I 11i:....iW, 2- 00 0-0
Special Condi - tio6s.: Restoration Fee:
Ct (41 Total Fee:
Receipt, No:
Assued b
y,
UPON COMPLETION OF -PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00. OF THE EDMONDS
COM ITY DEVELOPMENT CODE.,
FINAL APPROVAL OF PERMITTED WORK..
INSPECTOR'S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.