20070618103404.pdfCity of i;; ;{-
CONSTRUCTIONIssue Date:
A. Address or Vicinity of Construction:[
C. Contractor: - a C iL 4- - - _____- _ Contact: 0e°���
Mailing Address: tl,.3 15,s4b-0c-_ Ave._ A) Phone: X06
State License #:- t i t 1+ Liability Insurance: Bond: $
City Business License #:
D. Building Permit # (if applicable):
E. ❑ Cormnercial ❑ Subdivision
❑ Multi -Family Single Family
INSPECTOR:
F. PAVEMENT CUT: 2<1 S
CONCRETE CiTd': Q YES
G. ❑ Mail Approved Permit
e�
Side Sewer Permit # (if applicable):
❑ City Project ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
❑ Other
❑ Call for Pickup
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 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 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.
CALL DIAL -A - DIG (1®800-424®5555) PRIOR TO BEGINNING'WO CL
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature: Date:/2-5-A1_!9—/0"7
(Contractor or Agent) --7
(FORC "'IT[It ONLY
Approved y: � �� ° ��� ��� �J Right-4-wgyYee:.
Time Authorized: Vold After Disruption,'Fee/Fund,1'
'Special Conditions: tions: � Inspection Iie :
71e 4,6 Tectal Fee:
ecei t No:
Issued,by:....... _....... . _.
Job # C4
Date
an HY
Him
NAME
WORK AREA
3'x5/
ISPEED LIMIT
SIGN SPACING
LEGEND
28" TRAFFIC CONE
35
350,
30
200'
25
100,
(I 50'Seaftle)
�
=
IN
Note
1. All signs and spachn t I conform
Traffic Control specs.
2. Chonne|bing devices are 28^
traffic cones.
3.All signs are 48"x48" 8/Oun|enx
otherwise specified.
4.Alert affected residents.
5.Work totake place between 9o.m.
And 4p.m.
6 Maintain two 11' lanes.
7. Workgu'll be of C/L
SHOULDER
CLOSED
ROAD
LEGEND
28" TRAFFIC CONE
WORK AREA
TRAFFIC FLOW
WORKVEHICLE
SIGN LOCATION
IN
Note
1. All signs and spachn t I conform
Traffic Control specs.
2. Chonne|bing devices are 28^
traffic cones.
3.All signs are 48"x48" 8/Oun|enx
otherwise specified.
4.Alert affected residents.
5.Work totake place between 9o.m.
And 4p.m.
6 Maintain two 11' lanes.
7. Workgu'll be of C/L
SHOULDER
CLOSED
ROAD
q
L
LMM
`/ 79 L
1.99
?69'r
17)
......... . . . ..
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18522 18520