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�� � <br /> �yt� <br /> C yN <br /> O� �Q Date�o��"�1�'S �„�,�,�wo,�,rn,m��. � — j�� <br /> hd �41 meu ouo� .--�I- <br /> qpplir,ation For <br /> � xQ PUBLIC WORKS PERMIT °°"`""�,",'° s <br /> ro�eir�e - - <br /> H C7 len�enw ree ve�a S - <br /> � �� ba�ance Duc S�O On ____ <br /> e�• o Prinl or Type Only TO POSTING_ ���L' ti <br /> H <br /> � � y ,n,���l_1-li�_�l�_ '� ��� �r�� �lQ,��s <br /> �A l �h i ii��i�i. .��� � <br /> l7 y H Madin9 Add�ess ���Y ZiP hone <br /> Ownnr <br /> �`�'�`rL*�1 �_�-'703� <br /> H VJ � qpphwnt Mailinq Address Cdy ZiP Phone <br /> HOtn <br /> �escri6o Proposed Wo�k � <br /> —_ —. � <br /> FroR'r,A�Aressliln�iownl in � - 8�6�� --- � <br /> � <br /> Atta.h lour(4�r,opies ol plans lor Proposed work� Draw to scale and note�he lollowing as apPlicable� � <br /> • Proporry Lines • C�nledine of street <br /> • Outline nnd dimensions ol all exisling and • Indirate Norih <br /> proposud s�ructures on Ihe lot • Shcw any proposed 9radin9 changes <br /> • Existing and proposed utililies • Show measuremen!s � <br /> � ���� GO NOt W�RE BELOW THIS LINE � <br /> i <br /> � PERMIi CONDITIONS <br /> 1 � 1 All wlls lor Inspectio.shall be maAe 24 hrs in advcnce�phone 259•881 O � <br /> ' ��, � 2.All work shali be p^��ormed in acco�dance with ihi5 permd ano current Cily ol Ererelt Desi9n and Cons�ruclion <br /> �� Standards and Spea.tications. � <br /> i 3.Cell Location Underground Service 4H hrs.bebre you dig.TOLL FREF NU�ABER 1•800•4245555. <br /> II '�=' AL�WC<iC.Z(/ ___ O`�✓i� � <br /> _ x__ � ' � <br /> .� u <br /> -o��' - � <br /> !1,i �, oti .�� �.� �f -�...��,�;06.�.�� � �.�,�� -�� (� <br /> �,(�.i(t iGt,�u� ,.?�-C�i�' OOZ✓>'✓ J�OP7rL`r O?N�e. �eu 2�CGG��- � <br /> i1oc� ,a,.� �e"' 4'`u� ��/ a.t .ea�� �y/�»v��� .�-�- <br /> �.s ��i�. <br /> �, a.�,ti,<i,(� i,,,�,�ef��� �)iw��f .G> �G� t✓l,z�; �. <br /> i <br /> i � ACKNOWLE�G[MENT OF CONUITIONS <br /> \ _—_._-__ <br /> Thr unAersi9ned oH�ner/Tpphcant heret�y.i��ees to hnld,uid s.:ce �:�rnr <br /> Iess ih�� Gly ol @veietl Irem any an� all claims Irn Jan��a9es cos�s. <br /> expensP.S. or causes of aclion Ihat may anse beca�se ol mstallabon <br /> Q/)t� � /4[ _� �j anC mainlennnce ol �hc imProvement or o�her n9hl�ol�waY ��se hereto <br /> �' /J- T'� � -� / appliCd for anC lurinm a9ree5 lo remove Snme. unun nuticc Irom the <br /> Approve Or Construt ipn�'- �� at� GIY:�nd to�f�lace�wblic,properlY��ma9eo Iherehy <br /> �� _ . �~�-i� . � ., , � <br /> /��-, i, i , �' <br /> / / 1 �/ ^/ Y��. . <br /> ✓ � �('- �/ <br /> lI �� (`, <br /> " -��"_'y._c_-_'-_- ���_' —YS��L '�LL�------'ri <br /> f�L INSPEC ION .. Si9na�wy of APPlir.an� � i Dai�, � <br /> �nt��ovr,d:�s Consiructed <br /> WORV'vAUTHORIT[D BV THIS PERMIT ML15T 06 STAHTEU WITNIN <br /> �i.��.��q� PUBLICWGHhSDEPARTMENT tU0 DAVS OF DAT[ PEFMIT IS SSUFD AND THEfiEM7ER IS !O <br /> I w I 3:fi�':ntlar'.;In•el �[ DILIGENiLV PURSUF.D TO COMPLfTION 7HIS PFRM1UT 1.1A\' F�C. <br /> � �I Evnretl.WA CB201 C�NCELLED��THE CITY UPON AN1'S10PPAG[0=N'ORK ON 1 HIS <br /> ��� ppmm 2b)fisto Pi70JCC1 nVfR 9n DAvS DURATIOtJ <br />