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pate�'�7 F�o��w<„�s�.,m�a 87— 278 =. <br /> Bldp.Depl+ <br /> Application Fo� <br /> PUBLIC WORKS PERMIT PubTolaFec`PB 5 <br /> Less ApC�Fce PaiE S_.— - <br /> Be�anco0ue 5 '�d�, <br /> Print or Type Oniy ��C 90�/� <br /> L yN �A �osT 3/35 T��Rc..zP F_�r-R� T i �G�?.0 � �59-� 3:s8 <br /> Owner Mailing Address City Zip Pqone <br /> L.Uo-t.lz#3Y�Y-�56�- <br /> �a� <br /> Applicant MailingAddress Ciry 2ip Phone <br /> � /1 ��/ / '/ / � <br /> DescribeProPosedWork /icC/ ��.i � L�'i-iZ(' CZCC�R'l-L��ILLO cP� 7 �// C/c2�1!/ 'i:J'1 �Jdc;7' . <br /> �/�i ��-oh-� c�' iC✓.�u � ' �Fwff.2e-Z`.� �t� .aQ7Q�i � G <br /> T�f G <br /> W <br /> Project Address(il known) / � i L f� LS� EU,E/C',E T% � <br /> hltach lour(4)copies of plans lor proposed work- Draw to scale and note ihe lollowing aa applicabl�: � <br /> • Property Lines • Centedine of slreet ♦A <br /> • Outline and dimensions oi all exis�ing and • Indicete Norih V�� <br /> proposed siruclures on ihe lot • Show any proposetl grading changes <br /> • Ezisling and proposed ulilitles • Show measuremeMs � <br /> DO NOT WRITE BELOW THIS LINE O �. <br /> PERMIT CONDITIONS 1 <br /> 1. All calis for inspeclion shall be made 24 hrs.in advance- phone 259•881 5. q � <br /> 2. All werk shall be pertormed in accordance with this permit and current City ol Eeerett Design and Conslruction � <br /> Standards antl Specificationa <br /> 3. Call Location Under9round Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �.dC� To Bc f� /�i9x�inU�n f/E.-l>�/T � `/2 � O <br /> ���c� To B�' �oc�9i'�t� AS' �S':r9�c:�O 8£s/i.✓0 � <br /> T�EfS' Off' T�'� cOG-�' D�' P�✓Em�nJT. <br /> '- - ,.. .� __ , _ _ V/��/ <br /> FF.uGE %c� /'E ��6inc'��:`:� /� %�!�"' Sr.eFFT� i,',;:,UG19 ( ) <br /> /S /—"✓Ei.c' ii iUr'.t<'I,��L�.. ', .'Y1 6'�ll. :. \wN <br /> . , -�`�i..__ tl� <br /> � <br /> ACKNOWLEDGEMENTJF,CONDITIqNS . , <br /> The undorsigned o�:ner/aopi:cant hereby agrees to hold and save harm- <br /> � less ihe City of Ecerett from nny end all claims lor damaqes, costs, <br /> ,��] �,�' expenses, or causes of action thal may a�ise because of iostallatirn <br /> / / anG maintenance ot Uie improvement or other d(�htrol�way use hereto <br /> ' � � - -� � applied lor and lurther agrees t0 remove sa�•�e upon notice Irom the <br /> �pprov".d.tot 6onstru � n Dale City and to replace public property da.�u;� d tliere6y. <br /> C <br /> ��Z -� i� � / � <br /> .. < «�_ � �i�:� �- 7����� X- <br /> FINAL INSPECTION Date i — - � <br /> Approved as Construded Si�p�Qture of Ap�i}ican�/ � � Dale <br /> PUBLIC WORKS DEPARTMENT N'ORK AUTHCI�IZED-9Y THIS PEHMIT MUST BE STARTED WITHIN <br /> evcrett 180 DAYS OF DATE PER�AIT IS ISSUED AND TH�REAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. �i HIS FERh11T MAY BE <br /> E°e�e��' W�'98z�� CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: �59-8875 PROJECT OVER 90 DAYS DURATION. <br />