ENG20170266-APPROVED PERMIT.pdfCITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425)771-0221
*PERMIT MUST BE POSTED ON JOBS TE*
STATUS: ISSUED ENG20170266
Permit Number: ENG20170266 Expiration Date: 01/08/2018`
Job Address: 152 3RD AVE S, EDMONDS Location: 3rd and Dayton
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GO JEFF DORAN CIO JEFF DORAN
PO BOX 626 PO BOX 626
(425)293-5609
DISRUPTION INFORMATION
ASSESSED VALUE: $0,00 PROPERTY AREA?; 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 0 )
PARKING:- ( OXO) DURATION IN,MONTHS- 0 FEE $0,00; YEAR OF OVERLAY: 0 FEE: $0,00
ALLEY: ( OXO') DURATION IN MONTHS: 0 FEE $0 00
INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdrnonds or
any ofits 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 RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND AC C EPTANCE 0 F THEW ORIC
• 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
possesion.
• 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.
+r Three sets of construction drawings of proposed work are required with the permit application.
CALLDLAL-A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220'•EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS,
IS APPLICATION IS NOTA PERD
SPACE PROVIDED,
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RELEASED
AND RECEIPT IS
Printed: I
❑ FILE COPY INSPECTOR COPY E] APPLICANT COPY
110411
, OF EDA.1r1.
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RECEIVED,,`
JUL 0 6 2017 ROW PERMIT NO.: ENG % 702 �Y
OEVELOPMENT SERACES ISSUE DATE:
COUNTER
RIGH:T-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 4a Rb o (2
CONTRACTOR: 31Dov�S�u�- �d
Mailing Address:'
State License #: 3 koxcc �?
City Business License #`
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CONTACT: C1
Phone #:
Fax #:
Email #:�
Liability Insurance X Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial 0 Subdivision [] City Project Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes -?5�_No
ANY ASSOCIATED PERMITS. BLD# -2,0/6 - /0 ENG# _
DESCRIPTION OF PROPOSED WORK (Be Specific): -TI wo
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WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO 0 Year:
PAVEMENT CUT:
[:]Yes
No
If yes, indicate size of cut: x
CONCRETE CUT:
0
Yes]
No
If yes, indicate size of cut: x
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