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� <br /> r <br /> � <br /> r � <br /> 3 PuolicworvtPe�� — �� ��/ <br /> DeIC� ciea oaoi.•_l� � "/�' -- � <br /> qpplication For � __ — <br /> PUBL.IC WORKS PERMiT `°°"`""",`°° S =�" �� _ <br /> Tctal Fee <br /> lPv6Pppl.fRePdi4 '�. ��' � <br /> � Ov ' <br /> � . a.m_:e��, 1� —e— �._ � <br /> Print or Type Oniy <br /> l /1H�- � 1�����` �. i�rj'IJ-C'��,��_�.,:�✓�'F��—��F"1 , — --� <br /> O�aner <br /> ldail�d9l�dCress l —__' C,�Y :ip Phone.. <br /> / .. ���5:J�i..., <br /> i' (_p ��/. �'x'J.�Q�C'�Oyl-----��`_ �it{��_�y�_ ------ i <br /> —L���•'S��`.—� —5-----�N�a.linq AAcr�sss- '��iIY ZiP PttOnt . <br /> ApnliCanl � <br /> �,_�'_=r�='L.- <br /> Describe Piopoeed Work �_(�d14'_9�1�-tc - —'—"--"--- <br /> -,---- - -- ------ - ------- - W . <br /> ' -- ---.-------- �,., <br /> -- ,� _ <br /> Prolect ACdress(it F�.nc�,wn) __�F�L' / ��I..:I�_�'/i�.�--e .Ct1._...-- --'---_—.---.— <br /> �as �� <br /> � Attach four(4�ccpies ol p'�cn•:for propesed work•DraN to acale and note tne Ioilovun5 opP����rle. � � <br /> � • Praperty I.ines � • Gnnterline ol sireet <br /> • Outline and d�mensibm;ol all exi;ting a�;d • Ind�cate North <br /> propoeetl strur,tures o�i the to: � • Sho���any proF,,s�d 9�%�ding c��.an�jes - � <br /> 4 Ezistinr and propOced ai�li��es . • Show measur:;ments <br /> �r���s <br /> ��� �� DO NOT\M1 RITE BCIOW Thl IS LINE � <br /> PEP.N�f CONDITICNS � <br /> i, AII r,alls lor inspection s.hail bc�aEe 2a nr�in advancn�phene 259$815. <br /> 2. 4;f wak sha:l be performed ir accorcanco with this permit anU wrte�d Gity o�Everelt Desie,�ard Construction <br /> . aiar,dards and Spec���icatiorS. � <br /> � 3. C.II I.ocatior.Untle�yrountl�Service 49 hrs.belore you di�.TOII FREE NUMBF.R l-8UU•424•5555. <br /> l ' / 1 1 (+ . O <br /> f �LGe-s s j�' we w � �� e 5�a.�,I ��� � .^ <br /> a,��k?y �o••.�, ��n.S't+�.�laJ�w., o-d- w. e�e1".-vewoe✓� � <br /> ' r <br /> �,4ia�• tNa.��,.�.,��., `'� w� il �o� b� � <br /> ; <br /> �i - • 0 <br /> e.-„n � t�e , <br /> � � �� ;" <br /> , <br /> � �/ ACKNO'JILEDGEAIENT OF CONDITIUNS . <br /> The undec.ianed owner/aHplic:.nt horeby aprees lo hold and save harm- <br /> ���fff --- �"—" less 1hn City ot F.vero�t �rom nny aod e�l cleims lor d:mages, costs. <br /> �� y� � / .-� I expenses. or causrs ot action that m.,y arise becausr. ot ins�allation <br /> ' .�'���.,� // / ' Q and rnainicnance nt Ihe imprpvemrnt oi olher righJ�ol-way use hereto <br /> ,/_ ��lJLf___ Q- 7'�/ <br /> _1 applird br antl lurther a5rees to remo�e same uPon notice irom the <br /> q4 or.0 +S�ruction , Da e Cilv and to replaeo-public pyope�ry da�naged thareby. <br /> � \ <br /> ���g �'- �—L-,-l�`��� �' ( l�, I1/ _,. f, ,� � J <br /> FINAL SFE��TI DTte �--�- '�'"1��'f"""", �'�_—�)a�e— <br /> � \ Signalure o!Appliwnt � <br /> ApproveA as Crn�trdcted �� � WORK /.JTHORIZED BWTHIS PBRMIT MUST gE STAFiT[U WITHlP! <br /> �eve�eQ PUFiLICVJOPKSDF_PARTMENT 180 D�\VS OF DATE r'I.Fldl� IS ISSUED AND THEREAFTEFi IS TO <br /> 3^.00 Cedar Siree,t � BE DILIGENTLY P�RSUED TO COMPLETICN.THIS PEP.ti:1T MhV 6E <br /> F;verelt.WA 90201� CP.NCELLFD��'THE C�TY U7CN ANY STOPPAGE OF WORf:ON?HIS <br /> 2hone:259-P515 PROJCC7 O��ER 90 DA1"S UUR4ilON. � <br /> L . <br /> J <br />