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11749
560 HOMELAND DR
APPLICATION
for
The City of Edmonds SIDE SEVEM PERMT
104-05300 NEW CONSTRUCT -ION REPAIRS 0 EASEMENT No . ..........................................
OWNER ........... .A.1-1.en ... L-, Kincaid
------ ---------- ------------------------------------------------------------ CONTRACTOR ................................................................................. ---------------- PER11IT No . ......................
ADDRESS ........ 560-flom.l.and ... Ortyp - ----------------------------------------- -------- LEGAL DESCRIPTION: LOT No - ---------------------------------------------- BLOCK No . ................... ........................
NAAM OF ADDITION
GO
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE........ ............................ .......... By ..................... ........... -- ....... ................... -
CITY OF EDMONDS
COMMUNITY SERINCES DEPARTMENT
iRIGHT - OF - WAY CONSTRUCTION PERMIT
A. * Ow —.41 �,'Acurc-an Grig-sby
Name
_550 T-..'oiTm;1c,.nd Drivc-
Mailing Address
�_-.Cklab.n6z-, 7".*A 90020
City State Zip
9 Address or Vicinity of Construction: 0 U NO
Type of YVork to be Done: sphail
Permit No. IC - 435
Issue Date 0i - �9-10
B. 9 Contractor: 01cs 01,.�Fxqpi.c,
Name
100
Mailing ess
Lvnn, -
MCI 9001,�15
91-0837172City e__4X&ate Zip
I _ �; _`1 1 �',
0TjDS0 317BO - 40 77111�
tlepr
State License Number T on
'KNumber
Work in Connection With: El Sub or Rla�T I.Z 1,[N-%ingle Family 0 City Projects
t) r-
El Commercial El Multifamily 0 Utility
Pavement Cut: Xy ED N
U
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
M be made against the City of Edmonds, or a,ny,of its departments -or. employees, including or not limited to the defense
of any legal proceedings including defense' c-6441?0�urt c`o,st's,,1a,nd attorney fees by reason of granting 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.
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
W by City forces, at which time a debit or credit will be processed for issuance to
�th plicant.,
J'o V�� 0
e A 24 hour notice is required for inspection; Please call Public Works: 771-3202
9 Work is to be inspected during progress and at completion.
0 Restoration to be in accordance with City Code.
0 Street to be kept clean at all times.
*Traffic Control to be in accordance with City regulations.
e All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the
Signature:
that this permit must be available at the job site for inspection purposes at all times.
air,=
Owner or Contractor
Date:
Must Be Posted at the Job Site For Inspection Purposes
Call DIA11k1-
PIG Prior To Beginning Work
TOM TPn RV- Roy V,/ P-P.RMTT F-PIP.- Fn Q_e_ QCI�Q9-A
Z Time Authorized: Void after 600 —days. Security Deposit�
0
Special Conditions: NIEW 6ECOSDAW PRWY OT _rO Receipt No.:
EXCEED 12-, IN,wo-TH, Mrw CUR67bau, Fund I I I 'Fee: Aft
JN`ZTAk_LF_P aETWEENJ Q60TH Dv�IVENqAf5 PtND
Amendments: MiNl. f,- PFF-r r)F r_LjRf3 7D (3F, I Street Cut Dimen
PLA CF- 0 W P- S T Of:'- D R I v E VVA Y A N Q w oFS
eA%-r SF -ivu-CINJ PEP, Vf-7�WAL.. X
/V\ T-)
0
�14 NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
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.:
*1
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
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