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8 -.. <br /> n�:cnc�:n��..sw.�m�i• —�— <br /> Date�./22,C.91 oi�, o�o�.91/27369 _ <br /> qpplication For ' <br /> xr� PUBLIC WORKS PERMI"f PubhcWerbFee 5 <br /> Tolei Fea <br /> �9 y �esa aoo�Foc va�e 5 <br /> q�H oelanco Due 5 <br /> C x y Prinl or Type Only <br /> ri �3 <br /> y H <br />, K H� - 8 <br /> p x p Iarr Bethel 2110 Ffonroe Ave. � tt �. Y Z�P phone <br /> � y H Owner Maihn9 Address <br /> � Z <br /> �O'7� ��eT MailingAddress � City ZiP Phone <br /> � �..���yy Applicant <br /> 4��c� Addition to RFR — <br /> zH C Describe Proposed Work <br /> '� yz <br /> gi-+H � <br /> �'H <br /> cC� CC y � <br /> 3 [�1� 1 o n��nr�e_ <br /> Proiect Address lif knowN � <br /> ZH C/� �� <br /> H O ti Altach lour IQ)copies ol plans lor proposetl wo�k� Di,w to scale antl nole the following as�PDlicable: � <br /> � � • Properry Lines • Ce�ledine of street <br /> • Intl�cate North <br /> • Outline and dimenslons of all m�sting and • Show any proPosed gradin9 chan9es <br /> prOposed S�ruClareS on�he lo� � $hOw measurements M <br /> • ExiSW ia enJ proPoSCA uUb��r.y W <br /> �' �O NOT WRITE BEIOW THIS LINE O <br /> �o PERMIT Cl;4DITIONS � <br /> � � 1.All calls br i�spection shall be made 24 hrs.in advance-phone 259•BB10. <br /> 2.All woik shali he pedormeA in aCcort ance wdh this pennit and current Cdy o�Eveiett Design and Construction <br /> Standards and:necilicalions. � <br /> !��' 3.Call Loeation Uno�r�round Service 4�his.helore you tli9.TOLI FREE NUMBER 1-800•424-5555. <br /> a� O <br /> __ <br /> N o (��/ �.Ec� �,,,, <br /> � <br /> �� � '�E � (�C(�ADE S I�E�E�VC-.lZ TO v PC U/H�z.� O <br /> l i I.S un.�D��21•1E�y P�D(�1 i toV a <br /> � � <br /> � i i ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby aqrees to holA and savc harm- <br /> Iess Ihe Cily ol Evemtt Iwm any and all claims for dama9es, costs, <br /> expenses, or causes o� action thnt may arise because o� ins�alla�ion <br /> ' nnd maintenance ol the improvemenl or other ri9h4ol�way use hereto <br /> applied lor and lurlher aprees lo �emove same upon notice Irom Ihe <br /> qpproved for Construction Dale City and to replacn Uublic property dama9ed ihereby. <br /> FINAL INSPECTION Datc Datc <br /> qpproved as Constructed <br /> Signaturc of Applicant <br /> � WORK �UTViORIZED 8Y THIS PERMIT MUST BE STARTED WITHI <br /> PUBLICWORKSDEPARTMENT 1B0 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> '� 3200CedarSireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY Bc <br /> �'�"� Evcrelt,WA 9ffi01 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORY.ON THIS <br /> �� Phone'.259-FSt71a PROJECT OVER 90 DAYS DURATION. <br />