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18524 88TH AVE W
-PUBLIC WORKS DEPARTMENTj ENGINEERING DIVISION
THIS PERMIT MUST
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Applicant to Complete Parts A and B 0
A,, Permit to be issued to. D.
For Work at:(address or vicinity) /,,PS7,2--z C-,p 7�* 4 v&,
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Type of Work to be done:
(attach drawing when applicable)
Time Required Start: F . inish:
10,
Owner: SVC9.
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MT11ing Addresi���
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city Sfate Zip Telephone Number
Contractor: Va—m e 5_41re5 '4's
State License Number
Mailing Address
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..
Signature: Date: -12 - 7F
Owner or Agent
To BE COMPLETED BY IMSUING AGENCY:
Date Issued: Permit No.: 2 Fee
S e c u r i t y B o n d
Time Authorized: —
APPROVED B Date: