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7 � �'�� '� PupI�CWO�k�P5/mi�s � / � <br /> Date I?-1�-9� ��`��� <br /> �pplica�ion For l d�aa Dept��28 _ <br /> ['�� I vueM1c wmM Fee <br /> �� PU �LIC WORKS PERMIT ioteiiec 5 <br /> ,n�� rn nncTl�l� y -7 r13 �„s,.,�� F��a.,�� s-- <br /> � �.:,,.,.�_„ s��'d'' <br /> r�� Print ar TyPe Only -�-- — ..-- <br /> K �n <br /> O y O :Codd Kalanquin S11L 31st Avc ".�E �farysville 98271 659-5013 <br /> � �� p�,,��� L1�dm�7 ACdress Gty Zip Fho�� <br /> fq H <br /> H t" <br /> 'pzj pEij Ocmer � <br /> Ohy-1� _—_tl, .�i,��� _. . _.__. L:nilingAddr?Sc'— '—�. .� City ZiP Phone <br /> � �g <br /> G'�• C] new house <br /> 1--i pesr.nbaPropo.,eC`�votn _-_. -- __ <br /> ay� � <br /> rz — — — - -- — <br /> Ny <br /> H �n C cn <br /> �ij ��rJ Pro�nct �.idresslitknown� ��71 MLIJ�YI /�VL%t11.1f� _ _ � <br /> 2 H[/� <br /> H O V� nt;r!_i-iGur la;ton�es o�p�ans lor n:oposCd wo�k- Dra:: to f-�a'�� a�,C ncte Ihe lollowing cb aoPhCab:o-�. �� <br /> • Properfy Lines • Cenferhre of sireCt ♦A <br /> • Oulline and d�����m,�ons ol all nrishnn �v: • InAicate North V� <br /> ;•rGpc',etl sii�iCtun.�,on R'i= �'.. • ShOa+ any prepe;�-d qraAmy Chanqes <br /> • E>6liny 3ntl prCP'�=�'t1 uDld:. . • Sh.ow m¢asur�mr..q � <br /> � <br /> DO N011YRITE BELOW THIS LiNE � <br /> '�. � "'-F_RIJIT CONDITIONS <br /> 1� t F,il cal�s lor inspection shau be nade 2n hrs �n advance�pnone 259•8810 � <br /> 2.All work shall be peAorme:l in accortlance wit�this permtl antl wrrent C�Iy�,t k.c���nti Dus��n and Gonstrucp�n <br /> Standards and Specilicabons. <br /> 3.Call Localion UndergrounA Semcc�A hrs brlore you d�g TOLL FREE 1JUMBER�I•OOO•424•5555. � <br /> �^ ~_ <br /> .... „�, <br /> Q <br /> �� � <br /> r" � <br /> � � � <br /> 6��-� a <br /> � _ <br /> �� ,:f,Y.rJ01�LCDGCAa[NT OF GONDI110N5 <br /> ����, _ 7heuntlersiynedowncr;appLr,anthrreUyagrcestoholdandsaveharm- <br /> — less the Ciry ol Everet� Irom any and 211 claims foi Aamages, co� s <br /> � ekpenses. or causes of action ihat may uise because ol installa�ion <br /> i <br /> %� _ � � � , � and mainlenanr.e ofTfi�iii�rovement or other n��h!-ol�way us�� heretn <br /> - -- applied lor and lurther a �es to remove same �,i,,.n notice ��om tnn <br /> l�.ppi v• i r Con:��t�uction / Date City and O replace pu p�operty damaqed lhereCry <br /> ,�,,�/"1����----��-��`%�f -'� <br /> FIW;I�,INSPEC710N Date — - —__ -- <br /> npnrm•ed as Constiuctetl Signa � �A� �licant Dale <br /> �r,� PUBLIC WORKSDEPAR7MENT N' !{ T RIZE� BY THIS PERMIT MUST BE STARTED WITIiIN <br /> _� " O�DA95�OF DATE P[RMIi IS ISSUED AND THFREAFTGR IS TO <br /> /�, .�_, 92)OCedarS�ree� <br /> �����' �' E�r�rcfr.:�A�deco� L�L DILIG[NTLY PURSUED i0 COMPL[TION. THIS P[RMIt M11AY Bi= <br /> `Pcy;.� CnNCLLI f-U �Y 111G GTY UPCN ANV STOPPAGF.OF WORK ON i�1IS <br /> FI'�ono-;'S`3-f+R1U !'qU.JCCi'OVCH 00 DAY'i DURATIOIJ <br /> i <br />