22508 73RD PL W11111111111111
15002
22508 73RD PL W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT 'Permit Number.
j-0CJtW Issue Date:
$ GJ r
A. Address or Vicinity of Construction: Y 15 2Z�h , A rd P 1 W
B. Type of work (be specific): Replace 3 depreciated poles
C. Contractor: Snohomish County PUD No. 1
Mailing Address: P
State License #: -- 2
06
D. Building Permit # (if applicable):
Contact: Jerry E1 ki naton
Phone: 7 n n,ln
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Liability Insurance: Bond: $
Side Sewer Permit 11(if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project Xpg Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other , t
INSPECTOR: INSPECTOR:�-✓A 1
F. Pavement or Concrete Cut : ❑ Yes X6Xio G. Size of Cut: x H. Charge
APPLICANT TO READ AND'
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any hind 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 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 CITX- 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 o"ite at all times f r insp5rAion purposes.
I. ►.� -i.- •#
or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK.
FOR CITY USE ONLY
APPROVED: BYi q
TIME:'AUTHORIZEDi VOID AFTER -Mo' �0 DtAVS
SPECIAL:CONDITIO'NSi N A
20
COMMENTS:
DATE.
RIGHT OF WAY DEPOSIT
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