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F?!]H <br />��" <br />a� <br />A X1 S <br />C H <br />ay�n <br />rx <br />H>3 <br />y zH <br />h C) <br />H� <br />O x0 <br />'i H �J <br />(!J H <br />y r <br />[x-"] O � <br />H C7 <br />O H <br />xl c� C7 <br />Hno <br />c� � n <br />ri <br />z r, <br />ryz <br />HH <br />b cn <br />O �y <br />�i � n <br />z �; cn <br />H O a, <br />�a s <br />v f <br />�`a' e� <br />� ! <br />�_ � <br />Date— � �� _. <br />�`:'+� <br />qpplica�icn Fur <br />PUBLIC WORKS PERN�IIT <br />Print or Type Only <br />� <br />Owner <br />Desr.ribc ProposeC Work ` ��� � <br />,�roiect Add�ess �Ii knownl <br />Puaec wo.ws Pcrmi� • _ _ - <br />61�9 Oepi + . � <br />PummwuneFcc 5 — _ _ <br />iota�Fee <br />LessFpNF9pPaW S — <br />e.,iao�e o�� S <br />Attad� four �4) copies of G�ans �or proFosetl wo�k - O�;�w I<� scaie antl note Ihc tollovnng as apolicnbiP <br />H Property Lmes • Cenierline oi sireet � <br />• OulLne a�d tlimensions o� all exist�nq ar��; • Indicate Norih <br />p�oP�z�a Siruclures an I]� lol • S��er: on�� piopcse<: ��mdnn chsnyes <br />• Enisbny ;!ntl p�oPosetl cidities • Sbo�v �uasure�ents <br />P[RMIT CONDITIO.^!S <br />7. All calls �or inspection shall tc made 24 hrs. in advance - phone 259•E <br />2. All work shall be pertonnetl in accordance with this permd and cunent <br />Standards and Specifications. <br />3. Call Location Undergrountl Survice 48 hrs. belore you dig. TOLL PREE <br />�.,�., �� �� �, J�y ��'L9�yL� <br />� �ici <br />-.� ,.. <br />/l��-�- ��� �. <br />6� G� <br />_�„s � -_ � �� <br />i'=' '� <br />-. .�—:, <br />�� .� <br />� � � <br />ApProved tor Construction <br />FINAL INSPECTIO�J D. te <br />Approved as Consiructed <br />eoi•rrtt PUBLIC WORKS DEPAPTMENT <br />� 3200CedarStreet <br />EverelL WA 98201 <br />p, .:nr.�.: ."t3i0 <br />ne <br />�� C <br />, � <br />-'- . / <br />/� ,/J [.- �� <br />C� �'IV <br />C-�' �,_���:r .- - <br />, �� , i 1 i <br />� <br />� <br />``. <br />� <br />� <br />ACKIJOWLEOGEMGN7 OF CONDITInNS <br />The undersi�ned nwneUapplicant hereUy agrees to hold anU save h[um- <br />less the Gty ol cverett from any and all claims lor damages, ws�s, <br />ezpenses, or causes oi aclion that may ari�e becausc of ir.s�all..iion <br />intl maintenrnr,e al Ihe improvement or olh^r nph��ubw2y use hereio <br />applied !or and furiher a9rees to iemove same upon notice Irom t6c <br />City anA to replace puUhc Groperty daioaqed ihereby. <br />Si�JnaNrc ol Apphcanl ��1° <br />N'OFiK AUTHOR�ZED BY THIS PERMiT MUST BE STARTED �NI7HIN <br />180 UAYS OF ' 4TE PERMIT� IS I551IE7 AND THEREAF7Ef� IS TO <br />BE DILIGLNILY P1�F75UED TG COM1IPLE710N. THIS PERM1I�T f,14V E3 <br />C�PJCELLEO BY THE CITY UPJN AN1' iTOPPAGL O� WORK ON 71115 <br />f'R01f_CT OVtFl 90 DAVS DURATIOPL <br />