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��� <br />0 <br />9H{yfn <br />Hz�ti <br />� <br />� M � <br />N <br />-� <br />�Hxp <br />HG <br />Q M <br />�^�8 <br />M, Y � <br />2H <br />y.y <br />t HH <br />gy <br />f] tC7 y <br />i�1�+ <br />�Hf�i� <br />HOtn <br />�--- --_ _ <br />Date g�15/90 <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />W H Nel�on <br />[�..�TTi7 <br />5^.5 Tlnech 3t. L•'vazett <br />MaJmg Atltlress <br />IDesc�i�e Proposed Work <br />Ma�ling Addiess <br />at SFR <br />98203 <br />City <br />� �,���,� wo,,. �e,m, . _ <br />Eur.0 o.o� • �0 25358 _ <br />{'eUu.Worxefee s � <br />Tou�ven <br />�n.e �ow Fee va�a S . <br />n..i_,��.e o�� s _ <br />355-5746 <br />Zip Phone <br />Zlp Phone <br />Project Adtlress UI knownl ]so neacn �e _ <br />qitach �our 141 copies ol plans lor proposed work � Draw to scale and nole Ihe lollowiny as applicable- <br />• Property Lines • CenleiGne ol sVee� <br />• Ou�Gne and dimensiu�s ol all e.isim<,7 antl • InAir.ate North <br />proposed s�ructures on ihe lot • Show any proposed graAm9 chanpe5 <br />• E�isting antl proposed uti6hes • Show measuremenls <br />I��. PERMIT GONUITIONS <br />� 1. All cxlls for inspeclion shall be made 24 hrs. in advance � i.1.=^" ?a9•8810. <br />� 2. All work shell bo pedormed in accordance wilh Ihis permit and current Ciry ol Eveiell Design and Construction <br />i � �, StendardsandSpecilications. <br />3. Cell Locnlion Undorground Sarvice 40 hrs. belore you dig TOLL FREE NUMBER 1•800•424•5555. <br />l'' <br />���G'G LdGu'�i /"_,�j/ n'`_� /�'i � ,�(� �.'_ _ . -�, <br />I <br />Approvetl lor Cansimc�ion Datc <br />FINAL INSPECTION ���� <br />� Approved as Construcled <br />Pvrrrlt PUBLICWOFKSDEPAR7MF.N7 <br />� 3200CedarStreet <br />Everell, WA 9B20t <br />Phone: 259�BB10 <br />i;��� �',- � ��—" <br />�C� i- � � t <br />ACKNOWLEDG[MtNT OF CONDITIONS <br />Thc undorsign�A owner/apP6cnn1 heieby a9rees to holtl antl save harm� <br />less the Ctly of [veiatl Irom any and all claims lo� Aamages. costs. <br />e.penses. or causes ol aclion that mny anse Uewuse ol installahon <br />and mamlenanr.e ol Iha improvemeN or o�her nph4obwaY usr herelo <br />npPhCd la and funher aqrr��s lo rumove same upon nobce Irom Ihe <br />GIY anA to irPlar.i� Pubhc P�oPeitY dinmgeA IheieUy <br />Siqnalure uf APPbcanl Dale <br />WORK AUIHORIZED P_V 1NI5 PERMIT MUS7 �E STARTED WITHIN <br />lA0 DAVS OF DA7[ PERMIT IS ISSU[D AND TH[REAFT[R IS TO <br />�[ DIUGENTLY PUf75UED TO COMPLETION THIS PERAIIT MAv BC <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WO�K ON THIS <br />PROJECT OVER 90 �AVS DURATION. <br />