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23515 74TH AVE W11111111111111 23515 74TH AVE W DS PUBLIC WORKOSNDEPARTMENT 87REET FLE RIGHT - OF - WAY CONSTRUCTION PERMIT A. *Address or vicinity of Construction • .Owner: A�_- Name �eS✓ f AA �4 �i 1� � k4 � P+ Mailing Address City, State, Zip Code • Contractor. V Vo 0 Name J Mailing` Address p City, State, Zip Code Permit No. Issue Date • Permit Issued To: �• ,.9, i n h C. n3... • Type of Work to be Done. EL`'" • Work in Connection With: ❑ Sub or Plat ,;EK) Single Family ❑ Comml. / Ind. ❑ Apt. Condo. • Pavement Cut: ❑ Yes 9 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 permitymust be available at the job site for inspection purposes at all times. Signature: ��' ✓� �, 1h9"�'dVc1 y lrli'� Date_ Owner or Agent 0 * * 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 e f /') 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 -FIELD INSPECTION NOrV (Fund. 111 - Route conv to Street Dent.) Comments: Diagram: Contractor called for inspection,. Yes No .47ork Disapproved By: Date • By : Date: Work Approved By : — - Z__Date :Inspector: Ena. Div. December 19' �• �v. ✓ • ' REV 1 i7 E 2 9 � BTU UTILITY �lSTRi' � � l.wof-S�no4�wtm�sh:Covn!', PU C U L Nt3 y � • � ' Area iC kS`. y.•. .q ? �..i k q - I..��jl r ; r - - it 5 _.7' l Ot T 1 >• r ry iz •'4 Y •d -:.yx -'. `.'fi• •�;\s � . �_ y, *fNI:E. R a:. t 1'� , :a R,E+`V15LC3Nd' J`y•_:. � s� U..G. NO. - REA+$�C�),NIf•�Y�TaI? R '�•e� f�>, i© :1 v45}7Citptt+ T t 4SP �i'. '� r ,: ,�i•+y-c7�'� s. �T9�"1'��y� i�� a:3q.?.`.ry � `. L.'.:�y .� �.' '.✓'.94'�p'- ..d ir'yyYL �"-wt'.�WV' �d* '.�L y '� .�a f/y. " "S" '. � w� .l��1.'s is 4 '� � . Y . . , e t 'Q i t•' - -6� p �,. 1• S.- _! _ a .. TYPE ` „7, i�°' °r) �,Sg•o `. Z W1RELf , r` (1T+REQUntE�' -`� •.i iTREF [t1NTMjF1G ; « j gqpply�JATfXfMDT ? . uttQT 'EXEMMPi rJfm M. "7• r '>r >. r s 8DIAt�:DIG�, } .� a}SEWER , • PAitA _ �KcAz ` 't ,..7n"� r a s w r x ro " �� iD_ f' C,1fPR �GAs irk a 'Di"aE-iG �.t a� r� . e 8 a� TE IEIS€Ds BACK NOE Kv . F ES`RU?RFD r .d "r. 7ibRPJGiG`' "s ; tE hivCTt� + ` r CR ADD 'tC? iI PFI i I�7 24, '''�£b1 y fir. —PI h A t . y s ..,�,,,,; a a rA• ;r .+ - `L-.: #:' ,E'�- , Cp'rRiJ r E - • JK i' f T. +.. n TYPE QE T DgTE `�AkL6UNT1 t ATVE:~ G C._E. yy, ^t LOGS P TED SUt3'STATIQ4' S` `L L. `T� F 57 ClRCULT_., 0. --r �4:�0 RAN :F'. 4R S U� w PATE' WORKYCGMAPLETED p A $Y. Ft EYNAN : $,,OLE DEPT- CIRC. 'K DAT'E P*INTE0 t� - r 77I{ � - -; �. .. �.2. .. - �• • Mom+, � '' _ `- . e„ • • w Hr X'vr~. A 3 1c1N:'t,•_ - ... .. . Tt, r _ � � S �- ' _ o � .. ,:"-•sag' 7L. ' • IR,. u•. �:�i t3 t_c s v\ ,. , • - :� '* tea' 61SPATCkit POWD _ .1. ,MAP PAGE _ t W..©- NO. 4J�