20131 81ST AVE W.PDFi 1111111111111115328i
20131 81 ST AVE W
4ic•, t, •..� �F.,h"'�b#us ,r.+"� 3-�4 = �i �w�`� .y�,. ...4��i.�+: �('t 4R '�'��. p ` �37i'�� a='���—'�"{'1�f.,; �syn�
c'
I r
890
—�O
9
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
x p ai E Permit Number. /
S/
Issue Date:
A. Address or Vicinity of Constru_ct�ion: 2013 1 S/ Sr A �J
B. Type of Work (be specific): —1161 f N R 111MA Z l- 06 80,00 R
t�. YE"P pa R i Seo R E R IAA .
C. Contractor: &40. C t? , P. 0, Contact: go R KA K A Lf Y
Mailing Address: Z 10 19 L-1 �4 q9 Phone: (0 7Q - 32 14,
State License #: tl`a M6A)N-y iA)A 9 HOZ(, Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Sidek3ewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: I INSPECTOR: 1'",%IJ -,
F. Pavement or Concrete Cut: ❑ Yes ANo G. Size of Cut: x H. Charge _$
APPLICANT TO READ A IGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, 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, 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
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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.
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: )O—Z/- qt,
ontractor or 4JK0
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR: CITY USE ONLY
APPROVED BY: NW RIGHT OF WAY.:. DEPOSIT .
TIME AUTHORIZED: VOID AFTER.,.
SPECIAL CONDITIONS: MAl1VTR1 S
Ser F'ltok4 e-1 r?, V?l a r, e S
Pytoioos,et) TtLeAX4 ?Y
IF A n• Ywo� Skov n✓ o h�.✓� :,
COMMENTS:
!)t C'Q�I
DATE:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE: - • c)
TOTAL FEE:
RECEIPT FEE: ;
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
DEC 05 '96 10:56AM SOUTH COUNTY PUr .P 1 �4
• . . + f2:
b' ?
EP
RF'crF[A/r-.
Facsimile Cover Sheet
TO: ROS(,
Company.-
Phone:
ompany:Phone:
Fax:
From:
Company:
Phone:
Fax:
Date:
Pages including this
cover page:
\) iA� ck,.ZT
Rich Mom,
Sr, CUSTOMER ENGINEER
SNOHOMISH COUNTY PUD #1
21018 Hwy 99
EDMONDS WA 98026
206-670-3208 OR 1.800-662-9142
EXTENSION -3208
206-670-3210
Comments:
Auz Li
DEC 5 1996
ENGINEERING
9(,0-32-2
DEC 05, 196 10 ; 56AM SOUTH COUNTY PUD
City of Edmonds
CONSTRUCTION
PERMIT
AEC 5:1996„ •
FIGHT -Off' -WAY CONS
PERMIT rermit ter:
A Address or Vicinity of ClOwttuctiOIC 13 8� ST 1AJ
0 8. Type Of Work (be apwifia): mak' Chl R G.? 1ti1�'TA L L iJE t� t
890 19� �E'f R b— R 15 71"Q R e I
C. Contr1=17.._ - n 9 i� , �, Contac t: i90
Naming Ad&.= Z IOM , 91al 11 Phone: (o - 3Z +4' ;
It,a/4 9 �d2C, Liability LmrAn= Band:: S ;
Sty liae�ot:. !l: • Cla M •Ai , .
b. pudding Permit #, Gf applicable): Side Sewer Permit R (if applicable):
,Commercial 13 Subdivision ❑ City PsaJ°ct ❑ Utility ([313D. GM WNG. CABLE, WATER)
(] Jdd i -Family ❑ Single Family ❑ Other t
t �
INSPECTOR: INSPECrOR: ►�`"%
F. Pavement or CadCMW Cut' ❑ Yes No G. Sim of Cut r - 7t H. Charge ;
4 AlPPLICANT TO READ A. � N
;.
11VDZKjVITY- I App&IM and viands and by his ai8rmgere w rA" Wfka w^• -9- d of ' harmlerofromo • ar , 4',
• ' etai'm of any wnd or desertpdon whatsaa,arr for"� or,c,WarffACOt, �Itat m4Y be i the
of Fifrnonda. w &W/
o.ueerrlmitcdtothsdak++esota►{vle�alProeecdr� de rs,and feaebYr®asonol8�+��1}�e-';i„ s •'
�';, ievwivi'eeei indLatiir0 ,. ;< • �, • . . f._ . ',:.: '. �. � •• : ' ; '. :.: ..,'-.:' ,' ^,,.t : ; . ; ...... ' - ..:. ' .: • •;:;• .. � '' ,.
r,
„ NSHIP AND FOR A PAPA t7f ONE YEAR pOLZOWING
TJM CONTRACM)t IS IiMPONSIAr6 FUR Wt7RICMA 9 W=,BE i1lV77L THE FINAL STREET PA7C !
INyPECT1UNANLV ACCEPTANCE OF ME WORK. BSTiMATSD QN ESE
?Yi1UECE5.AfWHICiiTINEADEWTOR BEPROCESSFDFURI34UANCETOTAEAPPLdGtN1 .,- . �• r; u;
• L9 GOAH!tr4�� RYrCl v , _ -
~ win Of ed k required wi rt application. '
Y 1 .
Cons
n � on , a gr propo
Ple a Engineering Divis ^I 1-0220}y V : ''
hour Notice is required l?
ateri8l is to be d d ' i;'completion. '
Work -acid m tip':,--;: ..
rtianc ' with
Restoration It3 to be 1n s:CCo
Street i3hall be kept clean at all e rGC the City Engineer. :
Traffic Control and Public S atetY 9 be in ac ante with Ci re a na as rec
All atreet cut ditches shall be patched • th "ph or Cy ty approved materigt d of the working dap;
NO EXCEPTIONS.
r Tri;c•r s;' .,,'.' ' r • p • rmit will be
" rcruierstand thepermit regr�arnk
ements and thepiCopy of the p¢ wt
Ilaave'readAh 'abouestaternentseatid
available on site'at all times for inspection purposes.
Signature.,.Date: 1
j;Gontractor or )
CALM, DIAL -A -DIG PRIOR TO BEGINNING WORM{
4,
)�qE''tTL�..XAAY9
1 rY: i `Y'. 4 G1t �'�'�91 :r(. , iF �: y �r )�i' it1�� I �•1•
.}. .y.',.'' .: ;],.i;.l�. .i: _ i•.1.1'�q:.�<Y',, F'S1'P V�.IV11 V� Y t•l.:'.ftl'� �:: �h".•'�:�`R•',if -t'' C(µ-1. ,:� �.2,"ti'.,� {t...
:�;1 .�jr�'` ri �i.-t?�e••..• 1�P R7 r r Pt
k r ' 4 .Y{iV�YilcJ �, R'..,.w yY� "•M J { \ \ 1 ,ii: �. '� Y.�, ^V• t '7. •s,! M1 )i..,t •r`"J }
`.,�D nt'Ir,; r u S -t ,rt, c ,.,.t ?F.,�•
'1'IMg A(PIORiZED �OIAiAFT�'` , .i DAA.. 1 AJtSLIPTipN
oY.r.AA
Y till J`Lr^,S� r.•i'ts� E iin y.�' ! i ' J i'h. �''� i, •c tki„t.� t �1, 15 ,n,,:
,/y`•q��y s p- ls,VJ _ IGd3•�•��tA'+' Jt F •'�' 't, 1♦
,•VrLVYM. VoPh/11aot�Y+ J . , .. , .l� • • rl Y •, 4 Y J j
.PE .fit ,.. t. :+aO�T :-, ,•,r' ".
�P 'ft�+✓t ?G(•r�' =' f!1'r u' s., Pt±ziJ. " ,Y;.. > „' �,. ° .,�.;'
P��raj�4 'TPZt'N°
1•. y •J r f,N f •',.
.COMMENTS e at/I' r,i;. : ;r'Jp�: �: ,yr.t I'. r„
' DATE; _. '•Y88USn,gY:" ' .:
NO WORK SHALL BEGIN PRIOR TO PE ISSUANCZ tn$ ay.,"ll
I.
�ss
9w
tv)
V3
\J
uj
O Z
uj
O Z
S
LIn
re
i
r)
< z w
a 0