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1 <br /> , <br /> � <br /> � � 5 <br /> y - ----- - ---.. . . --_---.._._. .-- ---- --� -� <br /> O pC .. . . --- � <br /> Q I-� <br /> �� � Date � �6 �/ r � <br /> ae�K wo,..o„m,�. <br /> Kn Applicauon For 9�aa o.m • °��'� �`�3 � — »y2,('� <br /> 0 y '° PUBLIC WORKS PERMIT <br /> 0 �..o�K w�,.,�,. <br /> �v y �Ca ro�.�... s <br /> H r � ��f\AOCI[!����d 5 i <br /> � �� Pnnt or Type Only e.�.��.o�. s <br /> �,qHC <br /> ��� I <br /> ��--i1 ���,�-s �-0 3003 �/ L�ir-d.�c. /(� ,� -���� SPizv 3Ya-a �o � <br /> �y� Owner MaiFng Address City ' Zip Phona <br /> y y ,. �� <br /> ~ Applicanl Malllnp Atldrosa City <br /> n y Zip Phone <br /> � �" � � <br /> y �j DeaCribe Propoaed Work _ r �= O- <br /> HO (n <br /> W �� <br /> Pro�ect Addreee�u knownl r s3 i 3 �fT- sP o y�,1 �7 .�. yT 1/9 I <br /> AttaU lour(4)copiee ol plena lor propoeed work- Draw ro scale anA note Me following ee applicable: � 1 <br /> • P�oparty Linee • Canlerline ol sireet � I <br /> • OuUlne and dimanaions o�all azialing end • Ir.Gicate Narth i <br /> proDaaeC atructurea on tha lol • Show eny propoaeC pratling c�anges � <br /> • ExleNnp and propoeed utllitiee • Show measurementa � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> ��1 1.All calle for inspectlon shell be mede 24 hra.in edvenca�o�one 259•881 Q � I <br /> 2.All work ehell he peAormad in accortlance wiM thia permit anC currenf City ol E�eretl Design antl CansWctian <br /> Slandarda end Spea�icatlane. <br /> '�I 3.Call Lxation UnderQround Sarvice 48 hra.belora you dip.TOLL FREE NUMBER 1•BOO-4245555. � <br /> �� f� b<..� << c�/ ��.:,.,. F ;. .-Fc, �„ .F � � <br /> � <br /> 1 1 -�(�', <br /> ' ' / <br /> _ ]-3G �°� /w <br /> V� <br /> / O <br /> 1�1 <br /> � a <br /> 1 <br /> ' ACHNOWIEDGEMENT Of CONDITIONS <br /> ' The untlaraiOneA ownar/aoP�icant hereDy agrees to hold antl seve herm- <br /> iaee tha Clly ol Evare�l Irom any anG all claims lor Cemagea coets. <br /> ' ezpenses. Or causea of acUOn the� may ariae becauae ol mstallatlon <br /> antl mamtenence of t�e improvemant or other nghPol�way uee hereln <br /> . aOPlietl lor antl �urthar aqree9 Io remova eeme uoon nolite Irom ihe <br /> � ApproveE lor Construcllon Dete I Cify Bntl t0/EpleCe:lubliC OIOpEriy tlamagEE tf121eby. <br /> I <br /> �INAL iNSPECTION Da1e <br /> Approved a5 COn9lrucietl Signalure of ApD�iCant Da�e <br /> � PUBLICWORKSDEPARTMENT WORK AU7HOfiIZED 9V THIS PERMIi MUST BE STARLED WITHIN . <br /> J200CeAerStreet �80 DAYS OF �AiE PERMIT IS ISSUED AN� iHEREAFTER IS ip <br /> EveretL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE � <br /> Phona:25&BB10 CANCEILED BV THE CITY UPON ANY STOPPAGE OF WOPN GN THIS <br /> PqOJECT OVER 90 OAVS OURATION. � <br />