710 HANNA PARK RD710 HAN NA PARK RD
Inc_1Sgv
CITY OF EDMONDS
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221
Website: www.oi.edmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
Planning • Building • Engineering
October 2, 2003
Jeff Nelson
16034 681h Ave W
Edmonds, WA 98026
Re: Address Change Due to Change in Access
Dear Mr. Nelson;
GARY HAAKENSON
MAYOR
This letter is to inform you that due to a recent subdivision in your area, it is necessary
that your address be changed. This is so that your address is in accordance to the City
grid for Fire and Police. Your address has been changed from 710 Hanna Park Road to
701 Cary Road. I will inform all City Divisions including Fire, Police, Utility Billing,
Public Works and Building.
It is your responsibility to inform the Post Office, the Phone Company for Enhanced 911
emergency purposes and all other interested parties of this correction. We apologize for
the inconvenience this may cause you and greatly appreciate your cooperation.
Sincerely,
�
O-e�G-
Theresa M. Umbaugh
Permit Coordinator
cc: Fire Department
Police Department
Utility Billing
Public Works
Building Official/Street File
Snohomish County Assessor
L\Temp\DST's\Master Letters\Wddress Change
Incorporated August 11, 1890
Sister City - Hekinan. Japan
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION .PERMIT
A. Address or Vicinity of
9.•. Type'of Work (be specific): ls�N
Permit No:-1,W7-*
Issue Date:
— W11,
C. Contractor: 1 1 //� i�ILyM 6i&J G _/T._.L 0 Contact:a-(,SC)A -
Mailing Address: ( 3 L WJ /hon S-7 -C o I
��
State License # �L Liabi 'ty-Insurance:yns Bond: $ (�`.cxY) --
D.. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
**�(1#3 .
E. ❑ Commercial ❑ Subdivision. ❑ City Project ❑ EUC (PUD, VERIZON, PSE, AT& T, OVWD)
❑ Multi -Family Single Family ❑ Other
INSPECTOR:
F. PAVEMENT; CUT: ❑ YES ❑ NO
CONCRETE CUT: ❑ YES ❑ NO
G. SIZE OF CUT X
INDEMNITY.Applicant understands by his/her signature to this application he/she holds 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 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 of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL 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
flagger must betrained as required by (WAC) 296-155-305 and must have certification verifying 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.
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CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT LMUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
I _A� Date:
or Agent)
FOR CITY USE ONLY
Approved by: 1 l Right-of-way Fee: 'ITW �f.J
Time Authorized: Void After / / Disruption Fee/Fund 111:
Special Conditions: fb 9- FINAL, ilk sRestoration Fee:
1 - 02.Z0 x 13 �, Totaffee•
Receipt No: 67
,Issued- by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Ph e-771-0220, Ext. 1326
FINAL APPROVAL OF PERMITTED WORK: DATE: S�= 70
Inspector's Signature
For, inspection requirements see Engineering Inspection Information handout.
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DA My Documents\Forms\Engnmg\ROWpermit_ doc
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