602 3RD AVE N.PDFIIIIIIIIIIII
4902
602 3RD AVE N
APPLICATION
for
The City of lEdmonds SME SEVVER r1mam EASEACUM No . ..........................................
NEW CONSTRUMON [] RRPAM 0
113-063�0
OWNER........... W.t .... A-t .... PrQqtgr ........... ............................................. COMMACTOR ......... ........................ ............................................................... PEFJM No . ...................
ADDREss ....... U2 .... 3m! ... AY��, .... R, ....................................................
LEGAL DESCRnMON: LOT No . ...............
NAME OF ADDMON ..............
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Dye Tested On Sewer 1972
Approved:
DATE� ............................................... By
A
Ci ot t. o ds
RIGHT-OF-WAY CONSTRUCTION
PERMIT' Permit Number'
r Issue Date: X;R
A. Address or Vicinity of Construction: 602 3 AV N (9603972)
890 10 B. Type of Work (be specific): Install Service
C. Contractor: -Wishington Nattral" Gas . I Contact: Mariamne Kingsbury
Mailing Address: I 1) 2 -7 5 q t SW vuerett Phone:
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision El City Project Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family F] Single Family E] Other
INSPECTOR: 114SPECTOR:
F. Pavement or Concrete &t [3Yes 0No G. Size of Cut: - x H. Chargq�_$
2 cu
2- cu
APPLICANT TO READ AN. D SIKI (4-1 COO -
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ' , in�qt the City of Edmonds,1 or any of its departments or
aga I
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by re��8on ofkrantimethi8permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALSIFOR A PERIOD OF ONE YE" FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTILTHk F!MiL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
The
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements I and understand thepermit requirements and thepink copy of thepermit will be
available on site at all t inx ses.
. �P,�®r i
Signature: 5� Date: 11-97-95
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I V k L-.4t
TIME AUT'HORIZED: VOID AFTER 2-o—DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
,,DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE; 540 -
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE:. ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund I I I - Route copy to Street Dept.)
0 YES
Date:
Date:
13 NO