1004 SPRUCE ST.PDF11111111111111
13286
1004 SPRUCE ST
CITY OF EDMONDS Wr
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. •Address or vicinity of Construction
1004 Spruce St Plat # 164-067,007
• Owner: Washington Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 98007
City, State, Zip Code
• Contractor: SAME. AS ABCVE
Name
Mailing Address
City, State, Zip Code
PeW No. 80
Issue Date
• Permit Issued To:
• Type of Work to be Done:
• Work in Connection With:
❑ Sub or Plat IR Single Family
❑ Comml. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes ❑ No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this pert rust be available a� the'b site for inspection purposes at all times.
Signature: V. ate Sept 22, 198O
Owne'ItVrAWt
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after days
Special Conditions:
Ammendments:
Permit Fee: --®--
Security Deposit:
Receipt No.:
Fund III Fee: =_.,
Street Cut Dimensions
X =
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
, _ CITY -OF EDMONDS RECEIVED
4 .PUI C W0 DEPARTMENT, ENG I NI& I NGW IL I ON
J U L 18 1978
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PER blic Works Dept,
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to: I. 1I�. �, \ S 13V )A a C
For Work at :(address or vicinity) \ D O,
Type of Work to be done: 1 aL- 1,J Cv� vi 1� 13 7) VkL 2Z) A-0
(attach drawing when applicable)
Time Required -- Start: v r)-f Finish:
Owner: e• _1A , n . \ S xl 2 1�• U�.;
Name
Mailing Address
City State Zip Telephone Number
Contractor:
Name State License Number
Mailing Address STREET FILE
City State Zip Telephone Number
B, INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and -restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call'775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times. . n A n
SignatuA: / V/ %u ', Date: —/ % - 2t
Owner or Agent ri
(„ TO BE COMPLETED BY/ ISSUING AGENCY:
Date Issued: J
Permit No.:)g- /'7 s Fee:_�..s'�
Security Bond:_
Time Authorized: a cIA-JS
2_7
APPROVED B wDate _
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