ENG20170259-APPROVED PERMIT.pdfTATUS: ISS
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
ENG20170259
Permit Number: ENG20170259
Job Address: 8710 184TH ST SW, EDMONDS
MICHAEL'GALLAVAN THE GORDON COMPAN:
8710 184TH ST SW 13781 GLBRALTER RD
EDMONDS, WA 98026-5721 ANACORTES, WA 98221
LICENSE #: GORDOCIO71
Expiration Date: 07/07/2018
Location:
10/19/2018
DISRUPTION INFORMATION
ASSESSED VALUE: $0,00 PROPERTY AREA, 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE $0,00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 )
PARKING: ( OX0) DURATION IN MONTHS: 0 FEE $0„00`' YEAR OF OVERLAY: 0 FEE:$0.00
ALLEY: l 0X0 DURATION IN MONTHS: 0 FEE $0,00
INDEMNITY The Applicant has signed an application ivhich states he/she holds the City of Edmonds' harmless from injuries
damages or claims ofany kind or description Ii,hatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds'or
any of its departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLEF'FOR WORKMANSHIP AND MATERIALS FOR A'PERIOD OF 0NEYEAR FOLLOWING'THE FINAL
INSPECTION AND AC C EPTANC E 0 F THE W 0 RK
• 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
posseslon.
• 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.
+w Three sets of construction drawings of proposed work are required with the permit applications
CALLDDIALrA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220'EXT. '1326
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED, IN
SPACE PROVIDED,
Printed: Friday, July 07, 2017
//L62JZyGlldt 717120/7
RELEASED BY DATE
FILECOPY ® INSPECTOR COPY APPLICANT COPY
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
I
,111("' � $1)U
ROW PERMIT NO.: ENG
ISSUE DATE:
1141
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PROJECT NAME. CONTAC
Phone
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State LicenseL av
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City Business License 11"Liabillity iiusn�auee- Bonded
ADDRESS OR INTEWSECTION OF CONSTRUCTION:
El Multi -Family Single Family 0 Other
�;4 FUC VERIZON, PSE,
cAS`l', OVWSI)').
Is this pennit part of a blanket pennit? Yes [I N as
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L1VAX%%&"1V"'t MAIM# '112139M "All"11 1110 H"
PAVEMENTCUT: Yes No If yes, indicate size of cut: AI x
CONCRETE CUT: ves No If yes, indicate size ®f cut;
mwil�
. .. . .......
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RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE UMBER OF MONTHS)
Si al.48 I-Irs + ti LF X LF
Alley 72 Hrs + p LF X LF SF
Parking 72 Hrs + LF X S
APPLICANT TO READ AND SIGN
I "'I trlp nit's
'"Restoration is to be in accordance with City codes and Standards. All sareet-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 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
,?ny of its departments or employees, including defense costs and attorney fees by reason
of granting this permit.
I II ave read the ahove s understand the permit requirements and acknovvledge that I nnust
follow ai I requ ircq� �!Ji t "I Cr&� J
SIGNAL Yth pern"littobevatid,
"e DA
Y kTE
IZI'l ractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE