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(" l ' <br />Date , o�o.� �,,.. P.,m�� . <br />aiay o.o� • <br />pp0litaiion FOr <br />PUBLIC WORKS PERMIT "°:e:�::"' • <br />�.�..��...o.,a s <br />e.i.�:.Du. S <br />Print or Type Only <br />' Plan Check Nos B 37712 SEPA ; . <br />Appllcat.Date: OB/13/94 � <br />Job Addreee: 19b2 }UINIER AVE <br />Ownet: COUSINEAU, LEWIS �Zip � , . p�one <br />Owner Tenant: . <br />Propoaed Uae: SINCLE FAHILY RESIDENCE <br />Deec. of Work: <br />GABLE DORMER <br />Apphtanl Zip PhOne <br />OFFIC£ SET JOB SET <br />OeecriEe Pr000sed Wo APPROVED FOR PEPMITs OATt_/_/� BY__ <br />Prolect AOEress (�l known) — <br />Attach l0ur (4) Copie] ol plBns lor pmposetl work - Oraw to scale anA nole Ihe lollowing as appliteble: <br />• ProoertY Lines • Canlerline ol slreel <br />• Outline and dimenaions ol ell eaislina and � S�ow any pr posetl BraCinq c�enpas <br />propoSeC 51ruCiures On t�e �oI � ShOw measuremanls <br />• Ealsting and Oroposed ulililies <br />FERMIT CONDITIONS <br />�. All calls lor Inapaction ahell ba made 2a hn In ativence• Ot,one 259�8810. <br />7 Aii work s�all0e petlormad in accor6ence wll� Ihis parmil and curtenl Cily af Everatt Desiqn end Construcllon <br />SlanOarda end Specilicetlona <br />3. Call Lacetion Underproun0 Senice 48 hrs be�ora you dip TOLL FREE NUMBER 1-800�4245555. <br />� L;/JCep Cdc:..�%/'l:•i,.�f....r�' ,.:.�i <br />` . � �, <br />5 �i"-!' <br />4pprovatl lor Constmction �atc <br />FINAL INSnECTION Dele <br />40P�oved a3 Conslmcted <br />�PUBLICWORKSDEPARTAIENT <br />0200 Cedar Slreel <br />Fvcrett. WA 90201 <br />P�ona�.259�BB10 <br />Z <br />O <br />N <br />O <br />a <br />ACKNOWLEDGEMEt1T OF CONDITIONS <br />T�e unCersignetl ownet/appiitant �ereby ag�ees lo �old BnE save �erm• <br />iess the C�ly ol Ererel� Irom eny and all cleims lor eamepes costs <br />oapenses, or causes ol aclion I�at moy arise Cecause oi Instellation <br />and mainienan[e ol l�e impmvemenl or ol�er rigM�o4wey use �erolo <br />aOPlied lot antl luriner agrees to remove same upan nolice �rom Ihe <br />City anC lo rep�aCe PVOIit O�operty damaged Ihereby. <br />Siqnature o� Applicanl Dale <br />WpRK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITMIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br />BE DILIGENTIV PURSUED TO COMPLETION. THIS PERMIT MAV 9E <br />CANCELLED BV TME CITV UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJECT OVER 90 UAVS DUNAT104. <br />