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�-3(�-2 � �� <br /> Date���� PULLc WorF{ParmJ• '�3�__,_� <br /> Bt�, Da�t . —�I Z�_ <br /> Application For �. <br /> PUBLIC WORKS PER11flIT PuELc.Worx�Fee , __ _ <br /> Tolal fee <br /> , Lest AyD� Fee Paid S—. — <br /> 9qlenceDue S.Lr� � <br /> Print or Type Only TO POSTING_z z�_� <br /> Ci���. /„�� �d � ZI YnuK; I�teo q��5 3�"3 -707�� <br /> Own�-r✓ Mailing Address Cdy T_iP Phone <br /> ���%11v! <br /> Appliwnt Mailing Address Ci�y ZiG Phone <br /> Describe Proposed Work '\�P\v ��'� '""'��G ' Lzv <br /> - 1- -- W <br /> prOlec�Address fil known) �Q��n ��75\�/00.� �!��� � <br /> Attach four(4) copios ol plans lor prouosed work- Oraw to scale and ente Ihe!ollowing as 2ppi,cable: � <br /> • Propetty Lines • Centedina ol siree� � <br /> • Outline and dimensions ol all ezisting and � Indicate Norih <br /> proposed s�tuctures on ihe lot • Show any proposed grading chenges <br /> • Existing and proposed utililies • Show measurements M <br /> W <br /> DO IJOT WRITE BI:�OW THIS LINE O <br /> PERMIT CONDITIC'NS <br /> � 1.All cells lor Inspection ehall be made 24 hrs.in edvance� phone 259•8810. � <br /> 2.All work shall be performed in eccordance with this perr�it and wrrent Ciry of Eoarett Design r.nd ConstrucUon <br /> Standerde end Specificetions. <br /> 3.Call Locetion Underpround Service 4B hrs.br�lore you dig.TOLL FREE NUMBER 1•8U0�424•5555. � <br /> 4. S�F,rcc� �nd u�� I;�. �x tc�n 7tov�5 -�o -�� s �ro�,r-� s��l I O <br /> bG don� �-� �u ��reat�on o-F -�h� {��I�L 1�/oYK.S l�s�t�tor. <br /> 5 • Hrux s���l hP,+ ���'���klered �,�- ��re d��ar-�m�n� N <br /> r'{�C�viYCvyen{%s. O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> — less ihe G�y ot Everelt Irom any xnd all claims lor damages, costs. <br /> � expenses, or causes of action ihat may arise because of installa�ion <br /> �� and mamlenance ol the improvemenl or olher righl-obway use hereto <br /> �"� i� aPPlied lor and lurther agrees to remove same uPon notice Irom Ihe <br /> Appro r Const( on ^ �a�e City and to replace pub6c property damaged ihereby. >, <br /> j .� <br /> �:�- �-rir�Y.��_.—._ . '�.. /4'.. y' / � - <br /> FINAL INSPECiION a�e Date <br /> Approved as Conslructed ig Wre o 9ppllcant <br /> �A�I� yyp �.{(G ORIZED BY THIS PFRMIT MUST BE START[D WITHIN <br /> PUBLICWORKSUEPARTMENT 7gp�pqYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Stree� BE DILIuENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everell.WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BP10 pROJEGT OVER 90 DAVS DURATION. <br />