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ENG20170187-APPLICATION.pdfFTR PItC1J1�CT �1'1CIMBER ,2��it Cit} of Edmonds Permit Nae_ RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: OC 2 " y REMOVE POLES AND CABLE FOR A CITY OF EDMONDS SIDED Address Or Vi[tml'Of CORShIlCUOn; 238TH ST SW AND EDMONDS 1+Y,r,%-11Y 1�" 1peeW�tc) ALN IMPROVEMENT PROJECT, d';O Or'( C C. Contractor: PACIFIC CARLE FOR FRONTT R C l3cu DOW BRANDLEY MiflingAddress! 11321 EW 99S#10 State License 0 600-587-702 City Business License # Phonrr_ 425-263-5101 Liability Insurance: Bond; D. Building Permit # (if applicable): _ Side Sewer Permit # (if applicable) E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ EUC (PUD, f ERIZO,V, PSE, CO,IICAST, OYIySD) ❑ Nulti-Family ® Single Family ❑ Other INSPECTOR: F PAVEMENT CUT: ❑ VES © NO G. SIZE OF CUT X CONCRETE CUT: ❑ 1'ES Q NO G, ❑ Mail Approved Permit ❑ Call for Pickup ) ANC INDEMNITY. Applicant understands by hisfher signature to this application helshe holds the Ory 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 but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason ofgranling this permit. THE C0.ITRACTOR IS RESPONSIBLE FOR WORK11INSHIP AND AIATERIALS FOR A PERIOD OF ONE YEAR FOLLOW'IN'G THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTLVATED RESTORATION FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS CO.tIPLETED BY CITI' FORCES, AT W Inti TIAIE A DEBIT OR CREDIT JF7LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. • Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every dagger must be trained as required by (WAC) 296-155-305 and must have cerilrtcation vertrying completion of the required training in their possession. ♦ 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 DIAL -A -DIC (1 -SOD -424-5555) PRIOR TO BEGINNING WORK 1 HAVE READ THE ABOVE STATEIIENTSAND UNDERSTAND THE PERVIT REQL•7REMENTSAND ACIPNOUZEDGE THAT 111Mulpliv '" 13t" OF TII ° VITA VArLASLE ON SITE AT ALL TIMES FOR INSPECTIONS Sit,"nainrr. , Date: J (Contractor or Agent) 17-"" Ff1l f qlTY USE ONLY Approved by: _ Right-of-way Fee: Time Authorized: Void After P + Disruption Fee/Fund 111: Special Conditions: Inspection Fee: Total Fee; Receipt No: Issued by: REQUIRED INSPECTIONS: Call 425-771-0220, Ext. 1.316 for a 24-hour voice -recorded inspection request line, FINAL APPROVAL OF PERMITTED WORK: DATE: lntspeclt�t "s "Sil;acarture NO 1VORK SHALL BEGIN PRIOR TO'PCRAIH ISSU.ANCL -- 018 O S ✓yr ,yiu ,w W' c co i ° N ✓,i O w Ln mLo 0cm M I m m Ir.. 0 _ m LL w d .moi Y 0.N 5� .«C•r y OO N d 01= V 1-4 4i a" �I( gN � C pf4 a 7 r2 C C ', a VI d �"qqyy� A'cAm d�°"ate-�mrnnc�mrnaa %2 O q!'�'Z q Gk"pIL tlIFN� V NQ W o'L)oW A& w cn co 1 0 UJ Z ».rra . co W ��#��a wZaaHU W 3: O'D lig Il 101- a LL u ug �l 0 a 0 W W a a�W OZ W W Z 0�JLI) C9 W W 0 Z J J 0 % w 0 448 ?44Rev e W Z "' LL U j U ua0a Oz 'a— N Z O 2 2 '00, N 7 0 N Zt " U O rlN O m N L U(D M U) C L O M U J¢ 2 a Cl) o L F O O) C N U m u LLO U o C O : O � � m O d y q N.0 � mi' u `m E U' c y . 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