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PRoTECTNAME: ZOtt.l 3l
ROW PERMIT NO. : ENG
ISSUE DATE:
RIGHT.OF-\ilAY CONSTRUC TIO]\
PERMIT APPLICATIOI\
CONTRACTOR: p_e"\
Mailing Address:1
State License #:Èee,+aFpsrNs
CONTACT:
e Phone #:2o (n-q7 ó -ô3
Fax #:
h¿r
^fE Email #:rv K?fe *ú( c¿ì^r
City Business License #:I r,ianinty Insurance SËondeo
I Multi-Famity n Single Family n
ADDRESS oR INTERSECTION OF CONSTRUCTION: 7-_O(l
Commercial Subdivision City Project
Other
n EUC (PUD, vERrzoN, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?fl Yes E No
ANY ASSOCIATED PERMITS?
PI w FJ4'^on d)
Traffic Control (Only)
BLD#ENG#
3J" "l¿'n s LÐ 'r 5¡ +-DESCRIPTION OF' PROPOSED WORK (Be Specific) :
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RO\il \ilORK ASSOÇIATED WITH THE FOLLO\ryrNG TypE OF PROJECT:
Year:NOWAS STRBET OVERLAYED WITHIN THE LAST FIVE ($ YEARS? YES
PAVEMENT CUT: ! Yes f N
CONCRETE CUT: I Yes E n
If yes, indicate size of cut: xo
o
RECEIVHÐ
AUG 2 î- 'i,
"'
BUILDING
If yes, indicate size of cut:x
SFLFXLFParking 72 Hrs +
SFLFxLFAlley 72 Hrs +
SFLF'XLF'Sidewalk 48 Hrs +
DURATION
(NUMBBR OF MONTHS)
TOTALAREA
RIGHT-OF'-\üAY
CLOSURE
APPLICANT TO READ AND SIGN
*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 possession.
*Restoration is to be in accordance with City codes and Standards. All street-cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday - NO EXCEPTIONS.
Indemnity: The Applicant has signed an application which sfafes helshe 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 defense cosfs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the to be valid.
SIGNATURE DATE Ø 7-2.
or Agent
NO WORI( SHALL BEGIN PRIOR TO PERMIT ISSUANCE
CITY OF E,DMOI.{DS
¿c. l8
STATUS: ISSUED
121 5TH AVENLJENORTH - EDMONDS, V/A 98020
PHONE: (425)771-0220 - FAX: (42s)77r-022r
*PERMIT MUST BE POSTED ON JOBSTTE*
ENG20190108
lì.lGHT OF WAY PBRM IT (¿t-Subdivision)
Permit Number: ENG20l 901 08
Job Address:20114 83RD AVE W, EDMONDS
E4p iration Date : 08 I 2l I 2020
Location:
(-ONTRAC'I'ORAPPLI(-,{NT
REA L PROPERTY FLTNDING ROUP
gORYKERYOUNG
750 ROOSEVELT V/AY
TBD
SEA wA 98115 LICENSE #: EXP
DRIVEWAY APPROACFI AND UTILITY CONNECTIONS
INDEMMTY: The Applicant has signed an applicationwhich states he/she holds the City of Edmonds harmlessfrominjuries,
damages or claims ofany kind or descripfion whaÍsoever, foreseen or unforeseen, thaf may be made against the City ofEdmonds or
any ofits departments or employees, íncluding bul not limited to the deþnse ofany legøl proceedings including defense costs and
atlorneyfees by reason ofgranting lhis permil.
THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATER,IALS FOR A PM,IOD OFONEYEAR FOLLOWTNG THEFINAL
INSPECTIO N AND AC CFT¡NC E O F THE W O RIC
Traffic Conttoland public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must
be trained as required by (WAQ 296-155-305 and must have certification verifying conpletion ofthe required training in their
possesion.
Restoration is to be in accordance with Cþ codes. All street-çut trench work shall be patched with asphalt or City approved
material prior to the end ofthe workday- NO Ð(CEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIALA-DrG (r -800-424-5555) BU'ORE At[y D(CAVATION
CALL FOR INSPECTTON (425) 7 7 t-0220 D(T. 1 326
24 HOUR NOTICEREQUIRH) FOR ALL INSPECTION REQUESTS
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,toB Dıi( RfP't-toN
ASSESSED VALUE:
SIDEWALK: ( 0X0 )
PARKING: ( 0X0 )ALLEY: ( 0X0 )
$O.OO PROPERTY AREA:
DURATION IN MONTHS: O
DURATION IN MONTHS: O
DURATION IN MONTHS: O
0
FEE: $0.00
FEE: $0.00
FEE: $0.00
STREET DISRUPTIONTRENCH CUT: ( 0 X0 )
YEAROF OVERLAY: 0 FEE: $0.00
DIS RI JP-I'ION INFO RMATION
'IHIS APPLICATION ISNOTAPERMITUNTIL SIGNED BY TIIE CITY ENGINEERORHIS/HERDEPUTY: AND FEESAREPAID,AND RECEIPTIS ACKNOWLEDGED IN
òTALE TKU VIUbU.
APrinted: Thurs 201
{PPLI( ],{TION APPR()VAL
RB-EASED BY DATE
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