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/ <br /> � � � <br /> O�x <br /> C, M <br /> �Hx�n <br /> HZ� <br /> FC c] <br /> H� <br /> �Zp� 9.Z �/ � � �(i(,�� Puo�icwo,hsPermi�. �� / <br /> y d te- .��= S eiaa oeo�.. 38�97 � <br /> � �� Apalication For TO POSTING _���- <br /> �" � PUBLIG WORKS PERMIT Nubl¢Wo�keic! S <br /> �„� totniPoe <br /> `liH LessAppl FcePaiG g <br /> �"I <br /> lOaiance0ue S �� <br /> C V�„�i y Prinl or Type Only <br /> �Cy <br /> ��y� <br /> Kalanquin Todd Slli 31st Ave NF. Mar svil.le 98171 659-5013 <br /> y p y Owner Mailing Address City Zip Phone <br /> Oromer <br /> � Applican� <br /> Mailing Address City Zip Phone <br /> Describe Proposed Wor'• neW hOLL:.: — <br /> �,t W <br /> Roject Address(11 known) 2 �� 1 ''1�''�V �t'1 Avenu�._ f... <br /> Attach lour(41 copies of plans for propused wo�k� Draw to scale and note ihe following as apPliwMe�. � . <br /> • Property Lines • Cenlerline ol sireet ♦A <br /> f�' • Outline and dimensions o�all exisling and • Indicale Norih V� <br /> proposed struclures on Ihe IOI • Show any proposed prading changes <br /> ' ' • Ezislinq and pwposed utilities • Show measuremeNs � <br /> DO NOT WRITE BEL01N THIS LINE O <br /> � j PERIdITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•881n. � <br /> � 2.All wurk shall be pedormed in accordance with this permii and current C�ry at E eiett Oesign and Construction <br /> '�1 Stantlards ar�d Specilications. <br /> 3.Call Localion Undergro'�nd Service 4B hrs.be!ore you dig.TOLL FREE NUMdEH 1•G00�424-5555. � <br /> 1_I O <br /> i_� � <br /> _ � <br /> _� O <br /> ,_ a <br /> _�- <br /> / AGKNOWLEDG@h'ENT OP CONDITIONS <br /> �1. 7he undersi9ned owner/applicaM hereby ag�ees lo hold and save harm� <br /> �"U Iess :he Cdy oi It from any and all claims Gr damages, costs. <br /> /� �j1 ��� ✓ expens�s. cause ol action that may anse because ol installation <br /> �,( 1i�LYn,� �2z�y� and ma� c�nance Ihe improvement or olher riyhl�o�-way use hereto <br /> �-t/ ��- apph br and/ uriher agrees to remove same upon notice Irom ihe <br /> qpproved for C p truction � �a�P Gity nA to rep�ace public property demaged Ihereby. <br /> / <br /> �,-C�� 3 ''`' .y'3 / // 3 - �'� <br /> FlNAL INSPECTION Date � � — <br /> App�oved as Construcied <br /> na(ur of A plicant Da�e <br /> /�rE� R AUT ORIZED 8Y THIS PEFMIT MUST BE STARTE� \NITHIN <br /> PUBLIC\NOPKSDEPARTMENT 180 � GF DATE PEFiM1T IS ISSUED AND THEREAFTGR IS TO <br /> 3200Cedar Street BE DILIGENTLV PURSUEO TO COMPLEiION.THIS PEPId1T tdAY BE <br /> EveretL WA 98201 CANCELLED BY THE CI7Y UPON AN1'STOPPAGE OF WORK O�J THIS <br /> Phnne:259-8�1G PROJECT OVER 90 DAYS DUP.ATION. <br />