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Date ` <br />Applitation Far <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B J2119 SEPA <br />Owner nP,P1ob�Addreee: 53113W9iIGHLAND AO <br />C:mer: KO55 TIM <br />Tena�t: <br />Pro�.oeed Ueo: SINGLE FAMILY AESIDENCE <br />Applicanl Oe9c, of Wo[kt <br />FAY.ILY ROOM pODN / DECK <br />Describe Proposed Woik OFFICE SET <br />.108 SET <br />APPROVED FOR PEFUIIT: DATE_�_�_ By <br />Prolecl Atldress lil knownl <br />v�ou� we�w� na�mn • __ <br />ewp o�o� � <br />weiawon�v« f <br />mw re. <br />i.0 �oo� n� v.m S <br />6.u+a.ow S <br />Zip P�one <br />Zio <br />Alloch low �4) copies ol plans lor pm0o5eE work � Draw to swle and note ihe Iollowin0 as applica0le: <br />• P�Jperly Lines • CeMerline ol sireel <br />• Outline antl dimensions ol ull eeisling a^d • Indicale Nonh <br />praposetl slructures on Ihe:ot • S�ow any Froposed gratling c�anBes <br />• E�isling and p�o0ose0 utilities • S�ow meesuremenls <br />PERMIT CONDITIONS <br />1. Atl calls lor inspeclion ahell be matle 2a hrs. in etivunce- phono 259•8810. <br />2. All work shall bo pedormed In accordance with lhis permil end current Ciry ol Everell Design entl Cansiruc�lon <br />Standards antl Specilitatlons <br />3. Call Lwation Und�rp�ound Servica 4B �rs. belore you dig TOLL FflEE NUMBEH 1•800-424'S555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIRED <br />BY �' <br />DATE `' `' i ` <br />ApprOved loi COn5imC1i0n Date <br />FINAI. INSPECTION Dale <br />Approved as Conslmcled <br />�_� PUBLICWORKSDEPARTMENT <br />�3200Ce0orSvecl <br />EverelL \YA 98201 <br />Pnona:Y59�BB10 <br />ACKNOWIEDGEMEN70FCONDITIONS <br />Z <br />O <br />� <br />u <br />Thc undersignetl mmer/applicant �ereby a9rees to holtl antl save harm� <br />less the Lity of Everell Irom any and all claims lor tlamages, costs. <br />e.penses. or causes ol action t�at may arise because ol installalion <br />antl mainle�ante of tho impmvement or olher nghbo4way use herelo <br />applietl lor anE luriher aBrees to removc same upo� �otite Irom Ihe <br />C�ly anE lo replace pu0lic propetly tlamagetl Ihoreby. <br />Signalure ol Appli<anl Date <br />WORN AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />iB0 OAVS OF OATE PERMIT IS ISSUEO ANO THEREAFTER IS TO <br />BE DIUGENTIV PURSUED TO COMPLETION. THIS PERMIT MAV 0E <br />CANCEILED BY TNE CITV UPON ANV SiOPPAGE OF WORK ON TMIS <br />PHOJECT OVER 90 DAY$ DURATION. <br />