21102 72ND AVE W (2)11111111111111
14971
21102 72ND AVE W
j
•- r City oi'Edinonds
RIGHT=OF V'�AY CONSTRUCTION
Ir' ..
PERMIT Permit Number.
Issue Date: 5
A. Address or Vicinity of Construction: 21102 72 Ave 1B (1023741)
B. Type of Work (be specific): Install gas Arai tlm
C. Contractor: PUM SOUND ENERGY Contact: iQOW USI` ALO
Mailing Address: 1122 75t1a St SM Everett,.h®3 (425) 356-7520
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: KVJ t
F Pavement nr rnncreta rut ' 91 Yes 1-INo G. Size of Cdt. 11. X d H. Charee
APPLICANT TO READ AND /SIGN
INDEMNITY: Applicant understands and by his signature to this application to 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 any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit.
f, ti i
THE CONTRACTOR IS RES'PONSIBLEFOR WO&VIANSHIP AND AIATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCEOF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
~M BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO'THE APPLICANT „
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the *above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all, times for inspection purp ses.
Signature: � ®oU". d , a" Date: 2/25/99.
(Contractor or Age ) liU4A11tr
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK. -
FOR CITY USE ONLY 6
APPROVED Bf1'-- RIGHT OF WAY FEE: J V 1 00
TIME AUTHORIZED: VOID AFTIE4AY 4DAYS DISRUPTION FEEIFUND I I I: 1 /'10 p. 2..
SPECIAL CONDITIONS: N RESTORATION FEE: �y }
T OTAL FEE:
RECEIPT NO.: /l
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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PUGET
SOUND
ENERGY
ORDER# l D I
NOTIF# 30C
PUGET SOUND ENERGY 1122 - 75 ST SW EVERETT. WA 98203
Addendum to: City of Edmonds
Right of way
Permit Application
Submitted by: Tam Wood
ner Svc. Planner
Sound Energy
i6-7500 ext. 7587
Anticipated: i
KEY: --W--
WATER
--G--
GAS
-SS-
SEWER
-SD-
STORM