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C*1 Ci: � <br />p�x <br />C H <br />9 H p� <br />4 <br />y � H <br />�H� <br />'��J H 'i1 <br />fn H <br />H <br />x <br />�HC7 <br />OH <br />��g <br />�. � <br />zH�aH <br />rHH <br />g�' <br />H <br />C❑] C7 fn <br />[s1 � M <br />x .3 cn <br />HOtn <br />� <br />��' <br />�1',�� ,:: <br />Date�11� - . <br />(1n{)�IL3�lOf1 FOf <br />PUBLIC VI/ORKS PERMIT <br />Print or Type Only <br />� <br />Ownc� <br />a_.1.ee_ <br />Mailing <br />Atldress <br />���� <br />�esttibe Pioposea Work � <br />Prolect Adtlress lil known� 2��� "— �.�G'�N�i�i f/[/E. <br />Qty " Zip <br />✓ <br />, ; �� ,.,o,�,��,��,. ����'�� <br />i � <br />(I'n0 DlO� � � �� (�� <br />� <br />['�LecWO�MfFeo � <br />imei Fee -- <br />Lrsi Appl Fee I�aid S_ <br />1 J <br />ealana Oue S � �1—" <br />Attach low 14) copies o� p�ans lor proposed work - Draw to scale and note the lollowing as appGwble'. <br />• Property L�nes • Centerline ol streel <br />• Outline and dimensions ol all c*isting antl • Indicate Norih <br />proposed 5�ruclure5 on Ihe lot • Shr,W ,�ny pfoposed grading cha��y05 <br />• Existing antl proposed utiltlies • Show mea5wements <br />> f— ��_�=�-,_ <br />Ph.+n,• <br />P[RMIT CONDITIONS <br />t. All calls br inspection shall be matle 24 hrs. in advance- phone 259•8810. <br />2. All work 5hall be pedormed in accordance with this permit and current City ol Evnrctl Dcs,qn ar�d Con;Ivclion <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. Uelore yo�i tlig. TOLL PREE NUMBER 1•800•424•5555. <br />���Yl��..iii�'Lr. "���:-/:Jl'�i ..: r , . �- �I,. <br />o � <br />�'� � '��r. ��..� 6�.; ��, 1�� , , <br />`' `� � _ , _ . � ., <br />i ;���tn <br />�-�� <br />� w <br />,/ � <br />� <br />Approved lor Cons ucli ; .,-� Ie <br />�/�r �/ --�� "r'1 ''� dI <br />�,/ <br />PINALINSPECTION Date <br />��n�ovetl as Constructed <br />�•vrrr�t Plol WORKSDEPARTMENT <br />� 3200CedarSireei <br />[�rreU WA98201 <br />Phon� 25c,.pq�o <br />W <br />� <br />� <br />� <br />G <br />� <br />� <br />O <br />�i <br />ncKraow�Eocer,�er�� or� coraonioNs <br />ihr� undrrvq md uwneUapplicant hewUy agrees to hold aotl �-�vv hmm- <br />less it�r Cd� ol Gvnrei: Irom any and eil claims fo� <rrm,�qer. cosl��� <br />eapen5t�s. or causes of aciion lhat may anse becau.e of ms�allaP�.���. <br />and maintencnce of the improvement or olher ngh4ol-way use he�r�o <br />applied lor and lurihe� agrees lo remove same upon notice trom ti,�� <br />Ciiy antl to replace pubhc property damaged thereby. <br />W�yTKAUTHORIZED BY THIS PERMIT MUST 8E S7AFTED WIiHIH <br />180 DHVS OF DATC PCRMIT IS ISSU[� AND THFREAFTEF I� TU <br />6E GILI(nLNTLY PU� UE� 10 COM1IPL[TION THIS Pf_F7M1T 11AY E3( <br />C�NCLLLI 17 BY lHL CIT� UPOfJ i Nv SiOf'{ 9CE OF N:Of F C 9 1:-IIS <br />V'RpJLC i G r<N `�0 UAVG DUf;�'.iICN <br />