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✓ <br /> �. "' -�.S✓ <br /> Date . " ' � :..� ..;.< „�_..,.�.. �7� _. <br /> � �[x�1 tr'7'd '_ APPlication For r,iae oem . -_� , ;_ �) <br /> [�H PIIgLIC WORKS PERMI�' P��.;,a,e�`�° 5_ <br /> 9 H q� �ess�om vce cam S /1 _ <br /> N �'"f. paiance Oue 5=J4'�C.—_ . . <br /> y ��.. Piint or Type Only ---- -- <br /> K n <br /> H xi <br /> O x0 <br /> � �� � � � r � ��.�- �i rr�'-�� %�' � � <br /> W H - �1 ��.����_� `fi ti +�'�'�. ��' � i.�.�� _� �_ �–'i" � . ��' � "i <br /> y r Owner . Mailing Atltlr?55 C�Iy Zip Phonc I <br /> � O� <br /> oHg - >.� <br /> �–'Uj [�i7 Apphcaot MailingAddress Cny 2�n Phonc <br /> G]� C] <br /> � y� Descube Proposed Work ���� � �_2.��� <br /> r-�H <br /> g � -- - - <br /> H <br /> O C!/� — — _. __ <br /> � �" -- - � /��� � /� � �J� ,, � W <br /> 3 O� Prol�ci AAdre^,s UI knownl ,—//LfJ_�_1LS!�X � –µ'�"• � <br /> �____ <br /> :Jtdd� Inu�14)GOPiCS ol p13n9�OI prnpoSEtl w0lk� On�•: lo =c,-!4. .r�„1 nch.Ihi�lollmving a5�PFIiC3ble' � <br /> • PtOpetty Lines • Crnlerhnv ol Slreei /w <br /> • OufPne and AimCnsion5 of a!I r;.�•�.��.�� .,•�-:I • InaiWIC Nolth V� <br /> proPo59U sbuCNres 0��Ihe lol • Sho�ti�any p�npns�•i:yr:r:riy dianqo� <br /> �' Exw_Imq anA Proposqd utdtlies • S��ow measurrmrnis � <br /> p0 Y�lT VJ{911E Gf.LOA'J iN15 LINf_ � <br /> i � <br /> !.�� PERMITCONDITIONS <br /> 1.qil calls lor insnection snall be matle 2d nrs.�n advance�phc��e 259•8810 � <br /> 2.All werk shell be pedoimCd in ac[ordznCe with Ihis permd an�7 cununt Gry<-J Lu�icn Di.:.�yn an�f Constri�clion <br /> `« + Slandards and Speciticahons <br /> �� � 3-Call Location UntlC�yrotmil Seie�cc 4A his hr�lnrn�p�i����� TOLL FREE NUMDER 1•800�424•$$$$. <br /> � <br /> ' ' O� ,� <br /> �l��� � <br /> � <br /> � � � O <br /> � a <br /> _ <br /> _.�_ <br /> ACKNObVI Ef)GL hdENT OI� CONU:iIDNS <br /> ��� <br /> lh��unders�9ned owncilapplicnni horeUy agrecs�o hold and save harm- <br /> --�-- I�s, Ilie City ol Fverelt Lmn any .nd all elaims lor damages, costs. <br /> //� expenses. or cau;es of action Ihal may 2f�5C 6CC.]�S0 O� inSl.11i:fli0n <br /> c�������yy � _—/S[�U� antl mainlenante ol Ihe improvement or other nph4obway use hereto <br /> Appwved lor Conslruc or 7 p�� anP��ed lor and Imlher a9rces lo remove same upon nnlice frorn Ihe <br /> �. City antl to rePlocr,��mbhc n�onerty damaged Ihereby <br /> �'--c:��-� �'-' ��- � �,L <br /> RNAL INSPcCTION Date ��"�" 1J �/-�47 7����_ <br /> Approvad as Conslruc�ed S� na�u o� �phcant � —'Datc <br /> evcroll PUBLIC WORKSDEPARTMENT WORK �UTHORIZ[D BY TNIS PERMIT MUST E3[ STARTED WITHIN <br /> � 3200CedarStreet 1U0 DAVS OP DAT[ PERM1IIT IS ISSUED AND THLRE�FTER IS TO <br /> Lveretl.WA 4�201 BE DILIGENTLY PURSUED TO COAIPLETIDN. THIS PERIdIT MAY G[ <br /> Phonc 259{+H10 CA�JCflLL[D�Y THE CITV UFON AN1'STOPP�Ge OF WORK ON THIS <br /> PROJECT OVER 90 D�YS DUPATION <br />