9400 220TH ST SW11111111111111
16074
9400 220TH ST SW
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the- information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Issue Date• r7 -a 3 -
A. Address or Vicinity of Construction: 9400 220 St SW (9711555)
18-1-AdoworC) B. Type of Work (be specific): Install 44' of 2" 14PE IP Main @ 230' E C/L
9 0 1 9 95 #r,pm 141N to S.ytdge of..,R.O.I� n 220 St SW
C. Contractor: Puget Sound Energy Contact: Mariamne Kingsbury
Mailing Address: 1122 75 §e SW i! Everett Phone: 356-7500 X7596
State License #: 88203 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR: I I
F. Pavement or Concrete Cut : J3Yes []No
Side Sewer Permit # (if applicable):
❑ City Project [] Utilit 7(PUD, GTE, WNG, CABLE, WATER)
❑ Other
INSPECTOR:
G. Size of CuN�_ x _4
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds hdiml4 %rom5iniries, 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 legalproceedings including defense costs, and attorney fees by reason of granting this permit.
r
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.
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 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 purposes.
*` Signature: Date:
( ontractor or Ag nt)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W �; 1
TIME AUTHORIZED: VOID AFTER_ DAYS
SPECIAL CONDITIONS: ��fNhTC WITYJ
MJI'I TERt. A/1C G;?i iyTKA�-I'p✓L �IC. 4t r
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE: ? ' o c�
TOTAL FEE: 0 0 CD
RECEIPT FEE:
ISSUED
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments
Diaoram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
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