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1160 VIEW PL.PDF11111111111111 14530 1160 VIEW PL L i i T Uf t1il' UNW) 1t.4PUBLI*O DEPARTMENT, ENGINEE G ; ISION APPLICATION FOR RTnHT-nF-I,1AV rn!J4ZTDiirTTnf,1 DC -DM 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: P. LA, 0. *� % S &30'A0MIL-1 iA91 )-)� For Work at :(address or vicinity) . ( ` to b, Vi L It,) bpc Jo 131'N Ngbiona� Cpvlm Type of Work to be done: Y2— -91 y � VJ (attach drawing when applicable) Time Required -- Start:_ - Finish: Owner:o �, �, �� S �b Name Public works 1', i . Mailing Address C- �J 141y0to lko 36�- City _ - State Zip Telephone Number Contractor: Name Mailing Address City State Zip State License Number Telephone Number u P LRLE 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. Signature. Date: Owner or Agent TO BE COMPLETED BY ISSUING AGENCY: Date Issued :�o-�_�� Permit No. • Fee�j Security Bond: Time Authorized: ZD APPROVED B 10-771.. /n--_,-- ,% Date:/day ;?e - 4, 'N"* Revg10/77 ' LIC IIITY ®OGTRICT I,®ca4d®w l (� C7 \% 1 \�� bntaj,t� QRQA �Po � _ � Reason for wrw:C L7LINJS T. a21 C, �� d=�6e?`�� -"-� S¢c¢8©—-.v._�. �► Q oil ►83-� K� ..y G �C�MQC1®CJC7CC�pQd C,I3C3. - r Data- Orrc wod - - PP®¢cam vets, � Qffc GSA � i i�►e C��4�3 �� q�� U. VC Awa®va d 1 o Ow4oP aQ4®P�oC� Ro¢oavo� 4® • i{tict �sP CivcddP �a ' ®aPL, Qe0e030d Far C®Co wstruab®w ®aato Q� � ®otp WorkWorkwe�O�P� Circuit Nuwebe i a - ` 04 Ce?Pc�wa SWL3Pagiaa \N� Si � �► O.M. U.G. - �— not Cf�t FfT - {d CJ�Pcv io, Ov Ll Gas aa¢czhao szGI-S j a A � . Ll �t X 0 /L to u.cad - �` A j .0 Pc OL" tom, ,