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Date <br />Applicahon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ownei <br />Apphcant <br />Desc�ibe Proposed Work <br />PrOie[t AtlOress Pf known! <br />�1en Check Nos <br />Ap��licet.Detes <br />ab Addreee: <br />Ownar: <br />Tenente <br />ProFweed Ueec <br />Deec. of Work: <br />NEW GARACE <br />B 44537 <br />OS/31Z94 <br />96Y7 ELMONT DR <br />CARAELL CLAREN <br />GAAACE <br />SEPA <br />OFFICE SET JOB 6ET <br />APPROVED FOR PERMITi DATE_�_�_ gy <br />ouoi�r wo,.a n.,mn . <br />B�n9 Deo� . .. <br />a,�m¢ Won� fee <br />Tatri �ee S <br />�ev �oci ane va�a S <br />Baia�cn C�e $ <br />Attach four 141 coPi25 0l plans lui proU�seJ wo•. � pr�v. I� .; .��..---_��_----�'�--�--- <br />• uroPerfy LmeS � �''� n` r•'t���'o�luwing as anU6cabiN <br />• Oudine and dimensions ol au enynnq and � C"nlerhnr. nf slrpH� <br />proposeA slructures un the loi •�^d�cal� Nnrlh <br />• E.is�ing and p�oDo�od ulihlies • c���w ?ny rropoStA i�ratliny C�angr5 <br />• Snn�n rr,+asurements <br />PERMIi CONDITIONS <br />1. Ail calls for ins�vctlon shall be matle 24 hrs. in advance � phone 259•gg� �. <br />2. All wo�k shall be peAormed in accortlance wilh this permil ��d turrent Cify ol Evereft Design antl Constructlon <br />Standards and Specilications. <br />� �all I,ocalinn Underground Service 4B h-� belore you dig. TOLL FREE NUMBER 1�8 <br />00•424•5555. <br />�U9LtC WORKS FF,RMIT <br />N07 REOUIqED <br />BY <br />pATE � / <br />Phonn <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLED,riEP.1ENT OF CONDITIONS <br />____'_ ""'_" fhN�i�4pri��netlOWnPr,aPPh�anlhPrebYdgree5loh01tlantl5a�eharm- <br />� irss ;hN C�ty o� Evereu !rom a�y antl al� c;aims for tlamage�. ,-,osts <br />: r�Penses or causes of act�on that may anse because ol mstail�lier <br />-�- an,q m��nlnnanr.e n! Ihe improvement or other ng�obway use herelo <br />Approvetl for ConstruCtio--- - I acpi:cd ler anq I�rlher ar-ee5 to remove same upon nohce Irom Ihe <br />Dale � �,�y ,�itA to replace pubLc property damagetl Ihereby. <br />FINAL INSPECTION <br />Approvnd as Consiructod �ate <br />PUBLIC WOFKS DEPAq7MENT <br />3200 Cetlar Streel <br />Everat�. WA 98201 <br />Phona: 259�8610 <br />Sign�Iwe ol HppliCant <br />'NOFK AUTHORIZED BY THIS i�ERMIT MUST BE STARTED WITHIN <br />�8� �AYS Or OA7E PERMI7 IS ISSUED AN� THfP,EAFTER IS TO <br />BE DILIGENTLV PURSUE� Tp COMPLETION. THIS PEqMIT MAV BE <br />CANCELLED BY THE C!TY UPON ANY STOPPAGE OF WORK ON iHiS <br />PRO.IEC7 OVEF 90 DAVS DURA710N. <br />