20180102115819.pdf0� r 0-4.
A
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20180002
RIGHT OF WAY PERMIT (I -Sin-le Family)
Permit Number: ENG20180002 Exp iratiOD Date: 0 1/23 /2 018
Job Address: 7915 186TH ST SW, EDMONDS Location:
APPLICANT CONTRACTOR
SOUTHWEST PLUMBING SOUTHWEST PLUMBING
2401 SW ALASKA ST 2401 SW ALASKA ST
SEATTLE, WA 98106- SEATTLE, WA 98106-
(206) 932-1777
LICENSE 4: SOUTHWP071CB EXP:04/01/2018
spot
DISRUPTION INFORMATION
ASSESSED VALUE: $0.00 PROPERTY AREk 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: 0 x 0
PARKING: OX0 I DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: OX0 ) DURATION IN MONTHS 0 FEE: SO.00
IADEMNITY- TheApplicant has signed an application which states helshe holds the City ofEdinonds harmlessftom injuries,
damages or claims ofany kind or description whatsoever,foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
atforneyfees by reason ofgranting thispermil.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONEYEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WO RIC
• 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) 296-155-305 and must have certification verifying completion of the required training in their
possesion.
• Restoration is to be in accordance with City codes. All street -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 are required with the permit application.
CALL DIALA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESIN
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Tuesdav, January 02. 201
DATE
D FILE COPY F-] INSPECTOR COPY 7 APPLICANT COPY
If your project is SOUTH of 220th St.
and/or WEST of Hwy 99, it may be in
Olympic View VVater & Sewer District
SIDE SEWER
PERMIT APPLICATION
0
CONTRACTOR INFORMATION:
Company Name:
JQIG� U-,Uk (Aft
Site Contact:
Tda—iling Address:
State License#: CcAA&--r%7WP0-11CG
ExpirationDate: IVA02,Z,70
City Business License #:
PROPERTY INFORMATION:
l"hone #: 296 YZ? -72- 16
Fax #:
Email #:
0 Liability Insurance F-1 Bonded
Address: -7915 19-66 71 Yw y, wA %?0Z,,<
Owner's Name: I e
Phone #:
F-1 Full Line Replacement 2�Spot Repair El Pipe Burst El Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
SIGNATURE Z-ROY)4f / W914),KO DATE 117-Iloo
Contrador or Age"Int
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE