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, 6A1� <br /> •. � <br /> r i. ' , � <br /> ��p py�e 11 S 91 � � vutnc wor��Pa�mp• �I � <br /> � Appllcellon For eiaq oeoi�• 91/28191 I <br /> PUBLIC WORKS PERMIT Pu0licWo�k�ie� � <br /> To1�IFe� i <br /> �� leu�oo�fn�V�iO s , <br /> g�l�nce Oua / <br /> �� Print or Type Only <br /> _ A 9812•S 342-5828 � <br /> The Boein Oo. PO Hox 3707 M/S OF 76 Seattle, W <br /> �� 4 <br /> Owner Meiling Addrees City Zip Phone <br /> � Owner I <br /> � ADPlicent Melllnp Addrese Ciry ZIP Phone � <br /> aDeeeribe Propoeed Work �natruct maintenance platform around cooling tower _ <br /> �� •'` <br /> �� ��� Prolect Atldress 111 knownl _ _ 4 _ � . <br /> � <br /> Attach lour(4)coplee ol plens lor proposed work-Draw to scale and nole Ihe lollowing ea epplicable: � <br /> • Property Llnee •Cenlerline ol elreel � <br /> •OuUine and dimenslone ol ell exlstlnD end • Indicate Norih . <br /> � proposed sVucturee on the lot • Show eny proposed grading chan0es , <br /> • Exleting and proposed utl�illee • Show measuremenls � <br /> - . � DO NOT WRITE BELOW THIS LINE O <br /> C�� PERMIT CONDITIONS <br /> 1.All calla lor Innpaction shall be mede 24 hrs.In etivence•phone 259•8870. � <br /> ! 2.All work shall be peAormed In accordence with thle permlt end current City ol Everelt Dealgn end Conatructlon <br /> I 9lendarde end SOeGficatbas. <br /> 3.Cell Location Underpround Servlce 40 hra belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> C', �v6.�w��- �+.,<� ���«�N � ' <br /> ; <br /> �� � I <br /> �� //-Z-G- �/ i/� ; <br /> � `O <br /> � �1 � a <br /> I �1 1 ACKNOWLEDGEMENT OF CONDITIONS � <br /> Tho undersignod owner/nppliwnt hereby agreos lo hold aetl snve harm� <br /> U� lass Ihe Cily ol EvareU Irom any and all claims for dameges, costs, <br /> oMponses, or causes ol aclion ihnt may arise becauso ol inslalletion <br /> nnd maintenance ol Iho Improvement or other right-obway use herelo <br /> applied for and lurlhar agroes lo rumovo sama upon nolice ��om the <br /> Approved lar Construction Dale Cily and to replaca pu6lic property damaged thereby. <br /> FINAL INSPECT�ON O�1e <br /> Approved es Conslrucled Siqnalure of ApP�icant Date <br /> � PUBLICWORKS�EPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTEO WITHIN �I1 <br /> 1B0 DAYS OF OATE PERI,AIi IS ISSUED ANO THEfiEAFTER IS TO <br /> 3200CedarSirae� BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evere�4 WA 98201 CANCELLF.D BV I�HE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB10 PROJEGi OVE�I 90 DAYS DURATION. I <br /> J <br /> I � " <br />