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538 6TH AVE S
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City of Edmonds Permit No: (a
RIG -OF-WAY CONSTRUCTION PERMIT' ;'Issue Date: 0/1,2 E0
s 4�g7cftiity
A., Addres of Construction.
B.- Type of Work (be specific):' A) -1 Y",
C. Contract tc Contact:
or:
Mailing Address: Phone: —
State License#: PlZcWc Liability Insurance:— Bond: $
D. Building Permit # (if applicable): Side sewer Permit # (if applicable):
E. Commercial Subdivision M City Project E] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family E],, Single Family F] �Other
INSPECTOR-
F. PAVEMENT: r-1 NO G. SIZE OF CUT,5;�' H. Charge: $
CONCRETE CUT: �QNES F� NO
APPLICANT TO REA6'� DSIGN�
'by his1h . er signature . to this application helsh . e holds the City Edm6ndsharmlessfi�o—i�`
u rstands Of- n
IDEMNITY, Applicant nde 4jun
I Y. " " I . 1' rd;n"onds or
damagq'br claims of any kind or description whatsoever, foreseen, or unforeseen, that may bXm—a & -&gaiirst the City Of
any of. its departments or employees, including but not limited to the defense of any legal proceedings including defense costs -and.
attoMeyfees by reason ofgranting this permit.
THE CONTRACTOR -IS RESPOASIBLE.:FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK. ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL 'STREET PA TCH IS
COMPLETED BY CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic'.contr * ol and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) ;96-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt 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.
IRAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T IMUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
.,D
ate
Signature
.(Contractor or'Agent)
C L -DIAL�-AwDIG (1-800-424�655�) PRIOR TO BEGINNING,WORK
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T6 Uth, , Foid After- 1�� V 14 1 6 Disruption Fee/Fund'l 11:
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peciaV, - ondt ions. 40 t- P_ ti - �Ve IF-4e Restoration ]Fee:
re851nd7s. -rgwAa c, (-,alyag Total Fee:
Receipt
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UPO OMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
CT16N IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT. CODE.'
OVAL OF PEkMIiTED,: WORK. "j,
U
INSPECTORSSIGNAT RE D' E:
cilon ri fifo ii'-H'an' ut.
Forinspe requirenienisseeEnginee ng n . rination
NO WOR"HALL BEGIN PRIOR TO PERMIT ISSUANCE
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APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO . ............................. ..............
NEW CONSTRUCTION REPAIRS 0 LID NO ASMT. NO . ..................
RE &j j V th IT
&®r 777"
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OWNER ............. N .... a L -"- ........ PERMIT NO. -
.................... t4 ................. ---- CONTRACTOR 'rk ----------------------------------------------------------------------- ------
- -- ------------- .......... -rPEEGAL DESCRIPTION: LOT NO. ------- BLOCK NO - ---------------------------- ------
JOB ADDRESS .... 41F-� - ----- . ......... SC*J
0
DATE
. ..... By .... ..... . . .. .................
F,
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SEWER"-P I. -MIT
D ER.
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�_A- W,ATki,�SEW-ER.-DEPARTM-ENTY�t,;r.�,-,,.-..i,:�,
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the
-overing'�,any-,Portjon
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copstr�ct,on %7.
N0,7sat','.-Suh�,, or -holida cc
Inspection.,wp�, �c-prov!jLd, t6r,requi3t. o ns J.
6Nt'_0F'iC0NSTRUCT-10NC ........ ............................. ................. 7r'�Z-
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;''Y-OWNER A:ND/OR,-BUII��ER:��...:*..A..-.-:...�� ...................................... ......... . .. .. . . ................
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G VRACT*0R'S,,N .........................
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or ance,
in'iacc- �'Ath':_'dty-_,bf- Ed . mdrids
ordmances.
TION:�IS�CALLED.,T, d' 6-_A6,3stru.1'--
�'Ii. X.11censed' Side Sewer- Contract6r�*rn�u
NOTE No '�p�rrnit.'to: construcC s'swer �Jns'i�e-.�r4e'� st. 6e�.e;.PI6�
treci.area. �,66 not co*ver-any, po'rtion -s6w6r�before* it havIbeew Inspected.
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Right ofway permit�.. biaj a6w,66m-the City,Engincer's. office.
0
!eWers. w en-you.-ge
rd. k4ul'ations-- g6vernin g-- sildClj 1 'p*ehni
NC?TE No:-,.�3 —'Obtiln-J611.;I�eorrna:tion�- �egLrdting' or'�in'an"'c'e"'1.*I"1'6.03*6-,a
east . .. perti-' '2'%,. No -.-ben
a-zl2�i�ches'in'sIde,ijiFo line:. minimum. grade
VOTF�_ t!.l -'3
rm tte
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shkrbwthah�.
pe
�to, orlglnal�xond itioh..;�'6�'nfra;ciors -shall respon§ibl6"foy,*,failure,-�A-e'-'t'o,.'-I
develop- withiii -one-. j6L r: of -c�mpiiti6n
may.,
dr, do'sny:'oib�r %�o�k'. than, Is'provided forj In' -,,the- permit,' or- t6'do.an�'�'�vork on
,NOTI',� 6�-16s-,.ui�1awfult-to. �lter the ffi�� ain -sewer or s' appurtena&W excer) o.,In.
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9 PRIOR -To', Rec 4 �s 66c t i 6 fi`i
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heisi e-sewe:
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Thi City of Mmonds for
SIDE SEWER PeRmff EASEMENT NO - ------------------ -----------
NEW CONSTRUCTION E] REPAIPA<p LID No - ------------------ - ASMT. NO
J
OWNER ---------- ..... ��jj M CT
- ------ - ----------- --------------------- CON A OR -------
JOB ADDRESS ----- 4-9� -- ----- ..... PERMIT NO.
--------- ::5 ------------------------ LEGAL DESCRIPTION: LOT NO - ----------------------- -------------- BLOCK NO - --------------------------------
NAME OF ADDITION ------
Approved:
DATE
By------------------------------------------------------------
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