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; <br /> � [- ro -- <br /> � ��,�.,�.�•,���.���,,,,��. <br /> �o' � m Date 7-9-'�� � 91T27285 _ <br /> m,w o�v�.. ._-- <br /> y � t�n Appllcalion For <br /> r� rubi,c vmrxe Foo g <br /> f�UBLIC WOR►�S PERMI�T rmnirco <br /> y y � le.e Apol.fce Paid S <br /> a H �U BaL nr.o Duc � <br /> N H <br /> �a x � Print or T��pe Only <br /> ro y <br /> ,� 527-2085 <br /> H � t�i liarmon and Assc. 19401 40th Ave Sd C11y Z,P Phone <br /> Owner Mailing Address <br /> � H � <br /> r+ H <br /> Otanei CiIY 2ip Phone <br /> n O y ----�—" Mailin9 Addiess <br /> 4 qpplican� � �� <br /> � �' � ���) . '�` - <br /> y � y oescr�be Provosr.d Work TI - Retail store � . <br /> —.�__—__ <br /> _—�---- � <br /> _�— �1201 [ & i3 I' rt Tta71 fd�v_ <br /> Piolect Address(i� known) �� <br /> NI.ch lour(4)copies ol plans ier proposed work-Draw fo scale and note�Cenllerline ol stpee1cahle: � <br /> • Properry lin���s • Indicate Norih <br /> O Oulline and oimeneions ol all exisling and � Show any proposed g�adin9 changes aI� <br /> proposed slructures o�Ihe�ol • Show measurements ■ � ■ <br /> s Existing and proposed�lilities �j� <br /> .� DO NOT WRITE BELOW THIS LINE � <br /> i�_A <br /> I !- pERMITCONDIilONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phor.o 259•SS10. <br /> � � 2.All work shall be pedormed in accordance with this permil and current Cily oi Everott Design and Cons�mcUon <br /> Ie , Standards and Specifications. � <br /> � �1 3.Gall Localion Underground Service AB hrs.belore you dig.TOLL FREE NUI170ER 1•S00•424•555 . <br /> '_ � <br /> / �� ;, ii ��� , ��� /<�. i, _.��- <br /> i �� ��U�zE.'.c Gu^t.�-�- r' � t �/� <br /> �'i' �d' <br /> i � <br /> �� ^ <br /> Va <br /> 1 v�o� <br /> I <br /> i <br /> ACKNOWLEUGEM[NT OF CONDITIONS <br /> ' �. 7he undersi9ned owner/applieant hereby zgrees to hold and save harm- <br /> less Ihe City ol Evuretl Irom any �nei aL claims lor damac�es. costs. <br /> �1�' expenses, or cnuses ol nclion Ihat ��.Y 3��5o ��ecnuso ol Instnlla�ion <br /> and malntenance ol ihe improvement or olher ti9ht-ol-way use herelo <br /> apPlied lor and lurther agrees to nnnove same upon nolicc Irom Ihe <br /> Appwved lor Consiruclion <br /> Dale City and to replace public p�oDerty dama9ed Ihere6y. <br /> i <br /> Datc Date <br /> FINAL INSPECTION Signature ol Applicant <br /> Approved as ConstruW�:J WORK AUTIIOf712ED BY THIS P6FI�SIT MUST BE STARTED WITViIhI <br /> � PUBLiCWORKSDEPAR7MENT 180 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 6� 3200 CedarStreet BE DIUGEPITLY PUPSUED TO C01.1PlETION.Th115 PERMIT M4Y PE <br /> -n C.vrrAl`,WA 90207 GANCELLEO BV TI IE CITY UPON ANY STOPPAGE OF VlORK ON THIS <br /> � �� Phonn:2•��8810 PROJECT OVER�JO DAYS UURATION. <br />