705 5TH AVE SIIIIIIIIIIIIII
14704
705 5TH AVE S
City of Edmonds-
-OF -WAY CONSTRUCTION.
RIGHT
PERMIT
Permit Number.
'A
Issue Date:
11-36,
A. Address or Vicinity of Construction:
B. Type of Work (be specific):
9 0
C. Contractor: e=OMNAO"ks" Coum'V-1 Contact: Q\ (-)A
Mailing Address: '200\6 �AQ"� C15 Phone: (0-7 C.) - ?--acj a
State License #: CID"W�&,Uf\ !R&j 2 �, Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E' 0 Commercial [J Subdivision E] City Project M Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family [:] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes F—]No G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AN IGN
th
JNDEMNITY. Applicant understands and by his signature to this application, agrees to the City ofEdmonds harmllllrr��eolr6anageq, or'_
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made, a ainst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including deferi and attorney fees by reas?n ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS 4FA PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTIONAND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION WILL BE HELD UNTIL I I ET PA TCH
04
IS COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL B OCESSED FOR ISSUANCE TO THE, X! ZKANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the worki ng day;
NO EXCEPTIONS.
I have read the ab ove statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at 11 t' f,
c v or tion purposes.
Signature I It rA Date: 11
(Contractor d&gent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
COMMENTS:
FOR CITY USE ONLY
RECEIPT, FEE:,
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
I Diagram.:
"I
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
El NO
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