396429 Permit (2).pdfROW PERMIT NO.: EN+G
ISSUE DATE:
. 1 8C)
PROJECT NAME: WOOPWA4
CONTACT:
CONTRACTOR: W� pits d S l i �,�+ Illy Phone #:
Mailing Address; I, c y �'% � � r Fax #: ;!6L? �,_g1171)
State License : Email #: jh01st J A
City Business License #:
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: Z3WO iOtl ,-"/ r`` v k/ 6mw C
ROW WORD ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial N Subdivision El City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
El Other
❑ Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# EN G#
DESCRIPTION OF PROPOSED WORD (Be Specific) :
i"0«6;I A/4D �'700 °-rE INN <.:a lvc-_ ") 1.,/'1. r,
WAS STREET" OVERLAYED WITHIN THE LAST FIVE (S) YEARS? YES ❑ NO Year:
PAVEMENT CUT: ❑ Yes F1 No If yes, indicate size of cut: x.
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT -CIF -WAY DURATION
AREA TOTAL
CLOSURE (NUMBER +CIF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
—mParking 72 Hrs+ LF X LF SF
APPLICANT O 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 states he✓she 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 costs 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 oI', r for the permit o be valid.
SIGNATURE 1 DATE
Contractor or Agent
NO WORD SHALL BEGIN PRIOR TO PERMIT ISSUANCE