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CITY OF-EDMONDS Permit No. 9.0 - 3 9 S
COMMUNITY SERVICES DEPARTMENT
ciF _`OET FILE Issue Date 812-9190
RIGHT - OF- WAY- CONSTRUCTION PERMIT
A. 9 Owner: C V\ A �=, cvz, ex- -a_
Name
N 14 � t.3 C��7-
Mailing Address
7- . 9 �202_n
City State Zip
. r_7�r_ C
B. 9 Contractor.
,--Nam&
Mailing Address
City State Zip
State License Number Telephone Number
C. . *Address or Vicinity of Construction:. 5L4Q
Type of Work to be Done: �� "T 0 A C--s 12 (2 SG- -3 C — (�s, t--i c— Z -7
D. 0 Work in Connection With: El Sub or Plat 0 Single Famile— —L-7 d9114 Projects
)ZI,N El Commercial 0 Multifamily xutility
E. 0 Pavement Cut: El Y F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of 'its departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court cos&, and attorney fees by reason of granting this permit.
TONSIB -)EE TOR -NVPR
THE CONTRACTOR IS RESS J e , KMANSHIP AND MATERIALS FOR A PERIOD, OF ONE
YEAR FOLLOWING THE. FINAL 114§�] P4;k&I) ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by. City forces, a:f which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected duripg" progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with Asphalt or City approved material prior to end of working day;
NO(EXCEPTIONS.
I understand the above and that this permit must be ble at the job site for inspection purposes at all times.
Signature: 0, & �Ik Date: S� 1
X_ Own'l or Con tractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY:
Time Authorized: Void after days.
Special Conditions:
PERMIT FEE: i 30 -Tb Ut PS t LL $Lb
Restoration Fee:
Receipt No.: __
Fund I I I Fee:
Street Cut Dimensi
RELEASED BY: Date 81Z3 he') INSPECTED BY 11ULLF
NO WORK TO BEGIN, PRIOR TO PERMIT ISSUANCE
Fng� Div. March 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by.p. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
M " NID Ll A. LNJ,
PP-3P05r'_'D XIN6
S-71,5-66 P3 CA
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WATERL
METEP,
17-11
APPLICATION
The City of Edmonds for 1,
SEDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
105-09600
OWNER........ Er.i.c-Erickson ................................................................... CONTRACTOR ............................................ ..................................................... PERMIT No . ......................
ADDRESS —.&�--&th ... A.Ven*jLx --- S .................................... ................ LEGAL DESCRIPTION: LOT No...... ......................................... BLOCK No . ............................... ............
0
NAMEOF ADDITION .........................................................................................................................................
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE................................................ By ......................................................................