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7002 177TH ST SW
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City of Edmon�s Permit No:,='-_N�C)Z1+
RIGHT-OF-WAY. CONSTRUCTION PERMIT Issue bate: Z0_4��—Q_3
0 -7 1 T
A. Address or Vicinit� of-Constructi Z5 W
B. Type of Work (be specific): C�,_ La �4 C),�,- >1 P L - -r-, 01 C& La-41 11 l'i 1 1
q ll'PJ oi, C IL- o 1-77 20 Z) W + G �J 7
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Contractor: PI'L&U,_Lk
Mailing Addre ss: �3
State License i- C F1 C-T 10 1 t - n
Building Permit # (if applicable):
Contact: 1,q I C-Ic
Phone: 30 Lo I R - 4/� 3 9
Liability Insurance: . Bond: $
Side Sewer Permit # (if applicable):
E. r-1 Commer6al El Subdivision El CityProject F1 EUC(PUD, VERIZON, PSE, AT&T, OVWD)
-1ingle Family
E] Multi -Family' Other
INSPECTOR:
F. PAVEMENTCUT: EEJ�S El NO: G. SIZE OF CUT 0- - X
CONCRETE CUT: El YES 0 NO
AITLICANT TO -IZI,Al) ANI) SIGN
INDEMNITY. Abplicant understands by his/her signature. to this application helshe holds the City of Edmonds harmless from
injuries, damages gr claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or i7ny of its qepartments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRA CTOR IS 'RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE. YEAR FOLLOWNG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WfLL BE HELD UNTIL THE FINAL STREET PATCH IS
%-COMPLETED BY CITY FORCES, AT WHICHTIMEA DEBITOR CREDIT 97LL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT'
+ Traffic control 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) 296-155-365. and must have certification verifying completion of the
required training in their possession. I
+ Restoration 'is to be in accordance with City codes. All stfeet-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 a re r'equired with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MA KE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature. L-_W C_ Date:
(Contractor or Agent)
Approved by: ST M?jmlaf. I I � FOR CITY USE ONLY
LAI
Time Authorized: Void After
Special Conditions:,MJbkrftk1 s, 2E&UL ieg-m
I
.,0 --% tf +
Right-of-way Fee: frou
Disruption Fee/Fund 111:
Restoration Fee:.
Total Fee:
Receipt 'No: 1 42
Issued b
y
L5 J
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)'
FINAL APPROVAL OFPERMITTED WORK. W DATE: 29-0
Inspector's SigWature
For inspection requirement s see Engineering Inspection Information handout.
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Pilchudc Contractors, Inc.
Job #107017324
25 Sept 03
Sheet I / I
J. Buss
National Barricade Co
..............
Notes:
I - All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is 11'n/o ctl 177 ST SW
& I 1'W/0 CA 72 AVE W
3. Flaggers will control alternating
one-way traffic.
4. Alert affected residents
5. Channelizing devices are 28* cones.
6. Tapers will be 50' - 100' and must
contain at least 6 devices.
7. All signs are 48" x 48" B/O
unless otherwise specified.
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WORK ARU
28" TRAFFIC CDNE
-0- EMNG TRAFFIC
'3Z SIGN LOCATM
ft FLAMING STATION
EM PR07ECME VEWU
OR WORK WM61