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14267
19014 OCEAN AVE
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
9�
z a I"' V, E a rn
_. Issue Date:
-A. Address or Vicinity of Construction: R o 1-4 0 c E A N Qy E
In p B. Type of Work (be specific): T' RE E� CH K I w E6 R
�.. 1.8 9
e` 0 POWE K
C. Contractor: �S n . C A P. U .1 . Contact: jQ R K, A 1L A I. e V
Mailing Address: Z 14)�-S1- L� �� y Ct 9 Phone:
State License #: J9 A& 6) W b S UJ A A k6 Liability Insurance: Bond: $
�o .
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial ❑ Subdivision ❑ City Project ❑ T" il,iy (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family N ❑ Single Family. ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes ANo G. Size of Cut: ' x H. IChagg —'
APPLICANT TO READ AND SIGN f
INDEMNITY: Applicant understands and by his signature to this application to hold thq City�of,Edmonds harmless from inj�7ies,or claims of any
`damagesl
kind or description whatsoever, foreseen or unforeseen, that may be made against hl City of Edmonds, 'or any'of it's departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and 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 INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Two sets of construction drawings 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 completidn.
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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all times for inspection purposes.
Signature:
Date: 10 — 24 — g I
Q (Contractor otA-.Tg—ent) ."t
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK`
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 11.1 Route copy to Street Dept.)
Cdmment4,:,\.
A
CONTRACTOR CALLED FOR INSPECTION ❑ YES f E-1 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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