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Date <br />�� <br />Appllc�tlon� Fa <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />App�iqnt <br />Dsecribs Propoasd WorV <br />Pro�ect Addross pf known) <br />Plan Ch�ck Not C 13835 B�PA <br />1►�ulicat.Dat�t 03�18/94 <br />-Job 1Wdr���� 80 OLYMPIC BLVD <br />Own�r� MILLZR DU71Ni 11 <br />TtlINt f <br />Pzopo�W ONt dIl10LE TAMILY R�SID=NC� <br />D��c. oi Nork� <br />OONVtRT ATTAQRD 011R110S TO LIVIl10 Bp110E. <br />R�PL11C� MIIIDMI <br />OilIC� IIET _JOS 8ET <br />11PPROVED !OR PEAlIITt D71TE_/_/� 6Y <br />C. ) <br />�...�....... <br />�ra o� • — <br />NO�e Wpk� Fw <br />T01M FM � <br />LM� 11M� Fw hN i <br />YYnc� Ow i <br />Zip Phon� <br />Zip Pho�s <br />Attach lour (4) eopiea of plans for Dropwed work • Dnw to �c�le and note the •+Infl as �ppllc�bl�: <br />• Prop�rty Llm� • CE �.erlin� ol �trset <br />• Outline �nd dimunslons ol all axistinp and • Inc •ata North <br />proposetl etructuros on the lol • Show �ny propoted pndl�p ch�npse <br />• Exiat�np rnd propwed utllitles • Show me�euremtnt� <br />PERM�T COND�TIONS <br />1. All calls for Inapaction �hN� bs mada 24 hn. in �dwncs • phone 2b9�8810. <br />2. All work sh�ll be psAormsd In �ccord�nce wlth tAis permit and currenl City of Ewrott DNipn �nd Conatnictlon <br />Standards �nd Spscillutlona <br />3 Call Locatlon Underpround Sarvice 49 hra bsfore you dip. TOLL FREE NUMBER 1-900�4245b66. <br />DATE <br />Approved tor Coasiruction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cedu Stroet <br />Everst4 WA 88201 <br />Phone:259�8810 <br />PE <br />LIC WORKS PEqMIT <br />NOT qE0U1pED <br />ACKNOWLED6EMENT OF CONDITIONS <br />W <br />� <br />� <br />The undersl0ned ownar/�pplicant hereby �pro�s to hold �nd uve h�rm- <br />leas Ihe Cily o1 Evenit Irom �ny md �11 cldm� for dam�p��, eotls. <br />ezpenaes, or causes of actlon that m�y uis� Wuus� ol ImtHl�tion <br />and maintenence ot tha improvameM or oth�r riphl•ol•w�Y uN h�nto <br />applied for and lurther �prses to remov� wm� upon notic� irom th� <br />City and to reDlace public property d�m�qed thenby. <br />Sipneture ol Applicanl D�ta <br />WpRK AUTHORI2ED BY THIS PERMIT MUST 8E STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br />BE DILIGENYLY PURSUEO TO COMPLETION. THIS PERMIT MAV BE <br />CANCELIED BV THE CITY UPON ANV STOPPAOE OF WORK ON TMIS <br />nnn irr7 nvcn nn f�nVq (1��RnTIr1N <br />