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� � <br />H <br />>HV� <br />y�H <br />fg f] <br />H Rl <br />� N'il <br />NH <br />H <br />'Zo <br />O 1-� � <br />�/1�g <br />w,Y �g] <br />��yH <br />N <br />N <br />gdy <br />� <br />O� <br />Date-$ fj.-r�-' � <br />Appl¢alion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Maihng AAtlress <br />Meiling <br />r <br />/N • <br />�,,,.,, v:�,,.��.,m��. _ <br />��,�, ����� . 9//2�S9S'- <br />___. _'__- __'_._ _'_.. <br />r„m��. wn,.. r �. <br />mi.ir�. f _ <br />�.�a �na� h. nue 5_ '__ .. <br />9aianr. fn�n S —_ ___ _."__ <br />C"v � 9�'2v3 3�18-.� l�l� <br />Ci�y Zi� P�one <br />Ci�Y ZiP Phone! <br />Descri�e Proposod Work �2` ST CALLCA n - S� rS . -- <br />Prolecl Address lil knownl <br />4ltach lour (4) copies ol plens lor proposed work � �raw lo scale and note I�e lollowing ns oppGr.abin. <br />• Properly Linas • Centedme ol s�reet <br />• Ou�line and dimonsions ol ell exlslinB and • Indicnle Nalh <br />propoSeC 5truClureR on �he lot • Show nny p�opoSPd y�aAin9 r.hanycs <br />• Ezisting anG proposed ulililles • Show measuremenls <br />PERM�T CONDITIONS <br />(� 1. All cells lor Inspectlon shell be made 24 hrs. in advnnce � phone 259•991 O. <br />�� � 2. All work shell be pedormed in eccordence with Ihis permit end currenl City ol Evernll Design entl Construclion <br />� <br />i � _' Slenderds and Specilicetiona. <br />3. Cell Localion UnderBrourd Sarvice 4B hrs. before you dip. TOLL FREE NUMBER 1•800•424•5555. <br />�� � <br />� � <br />i) <br />�t'�/�ltt lt-r.'%� •_/�, .. .'� <br />:��...� �<< �. ��� <br />� <br />, �fi !3�.-�^� <br />'� ,,;.,i <br />/-- <br />ApProved Im Consirucllon Dale <br />FINAL INSPECTION Oole <br />Apprwed es Co�strucletl <br />PUBLIC WORKS DEPARiMENT <br />�� <br />3200 Cednr Stree� <br />Evaratt WA 90201 <br />Phone-259�8810 <br />� <br />O <br />♦�A <br />V/ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/nPPI¢nnt hereby agiees to �oiA and 5ave harm� <br />less Ihe CAy o� Everell Irom any and all clnims lor damapes, cosls <br />ea0enses. or causes al aclion ��al may erise betause ol �nslallation <br />end maiNenance ol Ihe improvemenl or o�her righDo4way use hereto <br />nppLed lor antl furiher ogrees lo remove same upon nohce Irom the <br />City antl lo replace public prope�ty tlamagod Ihereby. <br />Signalwe! ol ApplicaN Dale <br />WORK AUTIiORl2[D BV THIS PERMIT MUST BE STARTED WITHIN <br />Id0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE �ILIGENTLV PUASUED 70 COMPLETION THIS PERMIT MAV BE <br />CANCELLED BV iHE CITV UPON ANV STOPPAGE' F WORK ON TNIS <br />PROJEGi OVER 90 DA�S DURATION <br />-"r <br />r <br />� <br />