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9400 218TH PL SW
9400 218TH PL SW 9164067 file:/Al g. namsZmapslGasiPlatiTlF\Q164067.iIFL ii � N � � l985 3 19R-7 " N 1968 k27Ys N J 1446 ' Q 17iq� ' /B'48'N 1 o ^' H r N M83 W1,g7'N N m 83 As _Lo I Q W FOOTAGE TRANS--- SUPPLY- it 1165 067 DISTK« / Pf�9 �p8/Lt Q �-•��e, �` W c3Ec i KiG c • a ' City of Edmonds Permit No: l79 -03/3 `RIGHT-OF-WAY 'CONSTRUCTION PERMIT Issue Date: A. Address or Vicinity of ConsJction:�^•-'-^ ' B. Type of Work (be specific): , U01VIO(A.'e, 1 e.S� e td Q) k v211 D ig on d i �- / 6 r �s s v 1�a �j c1.s� ►- s` >y (1. ) L- _P s L__� t- La G' c 1 L_ 6_1 5 Lj C. Contractor: ` C � G � � Contact: 61 c_ JL Mailing Address: f 1 �J�..� V �r"� (I A✓ Phone:- 5 co - State License #: ((--(�, _ J )11 Liability Insurance: Bond: $ D. Building Permit #f(if applicable):# Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision -'`-ter`~''" ❑ City Project ❑ EUC (PUD, VERIZON, PSE, AT&`T; OVWD) ❑ Multi -Family ❑ Single Family. ❑ Other INSPECTOR: _ F. PAVEMENT CUT: ❑ YES ©-NO G. SIZE OF CUT X CONCRETE CUT: ❑ YES [:].NO 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 orunforeseen, 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 be trained 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 tren�rk shall be patched with asphalt or City - approved material prior to the end of the workday - NO EXCEPTIONy$. ♦ Three sets of construction drawings of proposed work are required with the permit application. CALL DIAL -A -DIG (1 8006424-55T�5) PRIORL,.O.BEGINNING WORK I HAVE READ THE ABOVE .STATEMEN S�.fND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE THE PINK COPY O THE PERMIT A VAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS 1 � Signature: Date: / 01 C 9 2 O (Contractor or Agent) OR CITY USE ONLY t Approved by: 6�1-)t4 ��i� l (,L, Right-of-way Fee:/A 1&o 1-0/-A /5. 1 Time Authorized Void After Disruption Fee/Fund 111: Special Conditions: �STUR a� VIA/ r0 _ /�S* f1 t N4LRestoration ee: f CO t)r ri ©r•,t Agitogiw A ` C(} Total Fee: At 2 ar--&-) a AI A N r•A i n, A S � kf I N i Pi unw S C- T= t?',� eoReceint No: n r1F s, 00AArissued by,,,' %kAJZ'or N md-, AL! UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326) t: i FINAL APPROVAL OF PERMITTED WORK: „, ,, w i DATE:,9 - q —a Inspector's Signature For inspection requirements see Engineering Inspection Information handout. NO WOIZK SHALL 13EGIN PIZIOIZ TO PEIZMIT ISSUANCE,