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� _ <br /> � <br /> ,�. � <br /> � ������ �r`",,m��w�,.,v.,m.� <br /> Date � , �. . __91/26932-- — <br /> ' Annlic,tlion For <br /> PUBLIC WORKS PERMIT "�°' N°,.�"° - <br /> �,.�. �.� s_ <br /> i.,.�en r..r.��i E <br /> n.� .n��. S , <br /> � � Print or Type Cnly <br /> H <br /> 9 y p�ein, Co, _ PO Box 3707 MS OF 76 � attle WA 9�124 266-3563 i <br /> �� MAilmy Addr�55 C�ry Zip Phone � <br /> H �� — <br /> �C � Owner - <br /> Applicant <br /> Mdding ArlAress G��Y LP Phone <br /> 'SI M�i1 —. � <br /> yV1 N[+ <br />� l�' Z$ ���tcr�be P�opos�d WorM _9uils1lnG 9��81_LtrailesJ_ <br /> : C <br /> � M C __ (u:places.lYailer_.455➢3) <br /> ��g -- - W <br /> � H � <br /> � y P�niect Adtlress lil knownl —.3Qp�W.�CAsino-Fd —��-- <br /> M y -----.— — <br /> � N Attach fow 141 copies ol plans lor pronos��A w�rk� Draw lo scale antl note Ihe Inllowing os ap0�ir,abir <br /> �"� • Cenlerlme ol streel ,A <br /> �Cy p1 • Property Lines <br /> Qrrrrrr • Outline and A�mensions ol all eKishng anA • Indmnle Noilh V� <br /> �s�� pioposed slruclwes on the lat • Show any p�aO�seA yraNng chanycs <br /> y • Erislmg and propuse.i ulililies • Show measuremenls M <br /> O V� W <br /> DO NOT WRITF BELOIN THIS LINE O <br /> PEHMIT CONDITIONS <br /> 1.All calls lor inspeclion shali ba metle 24 hrs.in odvance� phone 259•8810. � <br /> 2.All work 9hell be pedormed in accordence wilh Ihis permil and cunent Cdy ol Everelt Design and Conslruction <br /> �i Stenderds and Specilications. <br /> 3.Call Locetion UnderBround Sarvice 4d hrs belore you dig.TOLL FflEE NUMBEN 1-800•424•5555. � <br /> '�� <br /> 1 ' O <br /> � �I !'u�-c C..�n�AY f�,t�..,....f /IJo� '�a,u*n�*� � <br /> �— �� 'r_ ��� � <br /> � � 5-�-9� O <br /> !II a <br /> ACKNOWLEDGEMENT OF GONDIilONS <br /> � � <br /> The unctersi9neA owner/xDPhcnnl heret�y agrees to hold and save haim� <br /> _ -- — less Ihe GIy al Eve�e�l Irom any and all claims la tlama9es. cosis. <br /> ezpenses. or causes o� acbon Ihat may anse because ol inslallalion <br /> �' � �nd mam�cnance ol Ihe improvement oi other nght�o4way usr M1Freto <br /> � <br /> apnlie� lor and ludher o9rees to iemove same upon notice rom e <br /> Annroved lor Conslruclion Dale Gty anA lo rrplace public piopeity Aamayed t�ereby <br /> � � <br /> FINAL INSPECTION �a�e �21e <br /> l�pProved a5 Conitruc�eA Si9nature ol AnPbcan� <br /> WO{iK AU7HORIZED BV TMIS PERMIT MUST BE STARTED WIIHIN <br /> ������.�� PUBLIC WGRKSDEPAPTMENT 160 DAVS OF DATE PERMIi IS ISSUED AND 7H[REA�TER IS TO <br /> � 9700CederSireel BE DILIG[MLV PUFSUFD TO CO�APIETION THIS PERMIi MAV BE <br /> Cvmntt.WA 98?01 (;pNCELI fD OV THF QtY UPON ANV STOPPAG[OF WO�K ON iHIS <br /> P�onn 7fi9-BE71n � 1'fUl.11 C1 t1Vl I�90 f1AY5 DUfiA710N <br />