7118 156TH ST SW.PDFIII I iiiiiiiiiii
15599
7118 156TH ST SW
CITY OF EDMONDS
s UBLr KS DEPARTMENT, ENGINEOWIVISION. r
STREEi,p F�,. ON R-RIGHT-OF-WAY
LNSTRUCT 0N PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit -to be issued' to: TA1,0AaA7iS,v �oy,yTai ��:zj #/
For Work at:(address or vicinity) -Pw-P- f.S. ► j.-
_�O.PFST PARK Co�/Sr r,Ul 6, ,� rP�•¢3 9 /
Type of Work to be done: Tr?�ivcsr �,v or GI/
(attach drawing when applicable)
Time Required -- Start: Finish:
Owner: SNO. Co. P U, D,
Name
Mailing Address
770 - 2//Z
City State Zip - Telephone Number
Contractor: 5-&- E 4g 4AWP�
Name State License Number
Mailing Address
City State Zip Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees.
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit'(estimated restoration fee) will be held until
the final street patch is completed, at'which time a debit or credit will.be
processed for issuance to the applicant.
Work is subject to.inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: li?G/pf/1/ Date:
Owner or Agent
C. TO BE COMPLETED BY ISSUING AGENCY,
Date Issued:/v-16 —7r Permit No.:�bs—S Fee: ,00
Security Bond:
Time Authorized: ?o
APPROVED-B L Da _' _ •'
a:
lore PU ILITY DISTRICT No.l of Snoho nty�� uT►� CUNTYAREA
Re�.IU/77
Location "'1 I ! 1 5 [� sT• S. VV • n M , Date - W.O. No. S S 4� 4 1
a- W-i/4 S SZ-7 T_+ R Revision y Scale 1� = 2001
Reason for work. S' N C . I N Z ZE PEi - Engineer (a2NL. as 'S' 1 SW As Built
GQTCb �D1�I=�'t 'PA.TZV- C-nKICZ-r. U.G. File No. "'-
Z0 k W 1= Approvals - "
PERMIT REQUIRED IFOREIGN CONTACTS
Type C-1 TY ':aF Company GEN. TM►—.
E=:,M . J.P.N. No.
Date Granted
Fees required Yeses No❑
Log Posted I I Inventor Type PEEL). +- EWE.
Transf.Cardl I Pole Dept. Date 10Amount !S
Map Postedl I Circuit Map I
EASEMENT
Date Released For Construction
Date Work Completed By Foreman
Circuit Number ► 1 Cl 2 Substation
u0-- ----
L-4454X
ENVIRONMENTAL ANALYSIS
Exempt under District SEPA
procedures; Section III -A
Paragraph-17�a— Item 10
Dote 1 O ByS4-0,QF,-A S
Interpretation Referred To:
Date By
O.H. U.G. Cond
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Remv
Sewer
Gas
Backhoe
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kt Ft PH
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"t> I AL_ t::� 1 r '/
VC) i..T4-G_T.S _ - „-
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W.O. me. 1