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Date 2-5—�3 P�o����,o,.,��,m,�. �3 OS`f <br />ApplicationForT� PUSTING �/� emooeo�. 39470 <br />PUBLIC WORKS PERMIT °°°;;.�F�:`°° 5 <br />�,,..00<<.eP.,a s <br />e,i,��,o.� s 2000 <br />Print or Type Only <br />Stromme Const 9623 8th Ave NW Seattle WA 981I5 524-6821 <br />pwne� Mailmg Atltlre:�s Cny Zip Phone <br />Owner <br />Mailing Atltlre:s <br />oescribe Pmoosed work <br />Prolect Address �il knownl <br />Attach lour �4� copies of Plans for pmposetl wnrk � Draw lo scale anE noie Ine Ioilox�ing as applicabia <br />• Praperty Lines • CeMetline of street <br />• Outline antl tlimensions of all exlsting antl • Intlicale North <br />pmposetl stmctures on t�e lol • Show any pmposetl gratling chan9us <br />• Existin� anC proposed utililies • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be matle 24 hrs. in ativance • phone 259•881 O. <br />2. All work shall bo peAarmed in accortlance with ihis permil antl wrrent City ot Everelt Design untl Construction <br />Slantlards and Specilications. <br />3. Call Lowtion Untlerqmund Servica 48 hrs belore you dig. TOLL FflEE NUMBER 1•800-424•5555. <br />�— <br />� lLG� 1'�.CSL� � �lda.<x.� GCCr-�- /.'o��� 4.f��nd �UliG�c/ <br />c.n �ocw�a . c,l� <br />�jc./'..f -o�- L✓ut �e�� �"y� �ous� �` 1 <br />C�[+Y" di/ ✓Lalay �Z^7�am%��zi - %�Y �� C Gf�iiYc B� t1 ojo�A�l. <br />/ <br />,>� Sv.�.feu,�xy �fia�/'ouT� �v ,a�,���'�m, D::Eo �o�u ' <br />L;. L//Jlr1Y�v szu•`ccv .�a_l.'F'Gt ,i-�/�-�i.�a�,{/�.•� S,Jm.-t.C�-41.:s7` Co7�w �./cJ�` <br />7 M1=r�C+:Q� an.e�. �.S�czo-..dihz(,..¢�.0 C�iaC�a��: <br />3, t�»�E'('m c.ry.aZu<,e?ir,� ,�'.t..,ee mn •":�e �'�/,a-n. SF/. �'nm..� <br />-�,c� �--�:� +'�-�`,�:,.�. ��,�.�rr s:�:u� .�..�. �.�,,.� �c, o;.,.»..— <br />/z� s1�cE, q��.(.� c�uw-t..�� a�r�-_ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�` ���cc��� 3//9s <br />nn��a�etllorConsiruction � D� <br />/� �Y / <br />�t—C -Ce_JL� .:>�_ %/7 �J <br />RNAL INSGEQION Dale <br />npn�evetl as Consiruetod <br />�` PUBLIC WORRS DEPARTMENT <br />�r ,y 3L00 Cetlar Sireet <br />�=��n EvcrcU.WA9B201 <br />�'� Pi.ane�.253�9�10 <br />W <br />H <br />� <br />� <br />O <br />V+ <br />0 <br />a <br />T6e untlersigned mvne4applicant hereby agrees to holtl and save harm� <br />less �he City o� Everelt Irom nny nna all claims for tlamafles, costs. <br />e.penses, or c�wes of aclion Ihat may arise becnuse af installation <br />antl maintenance ol t�e impiovement or other rig�4ol�way use herelo <br />applietl IOr antl lunhe� Bqrees to remove same upon notice Irom t�e <br />Cily antl to replace pubhc property damagetl thereby. <br />� � � <br />Si9nalure o� Ap� Dalc <br />WORK AUTHORIZED OV THIS PERMIT MUST BE STARTED WITHIN <br />IBO DA` 3 OF DATE PEHMIT IS ISSUED AND THEflEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />�ROJECT OVER 90 DA\"S DURATION. <br />