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� <br /> ;`< . ` � � <br /> ` '�'i I Z. <br /> a„oi�c wa�xs amm • . � <br /> oz�e_� .__"tC : � <br /> Emq ocn� + <br /> i�pplica�ion For <br /> y"H PUB.I.IC WORKS PERfOAIT <br /> PUCI¢Works Lee <br /> �r y iolal Fee S <br /> � <br /> ,:•H <br /> ��x Less AOP��FeC Fai� S�_ ,,. <br /> Cy' H BaianceDue S ZL' �— _ <br /> r yxy y Print or Type Only <br /> H z� <br /> K �� '".l . i�. � /�1� . � � � � -����,'I l .�l �� •�� � 1 �) � ��� �, <br /> o x o � 1 i'I � I �I( ( I"1'1J) I j_'"�('I,j.,_� ���,' '..��—�.I���� � � ��- <br /> � �H Owro�r Med�ng Address C��y ZiP Phone <br /> z ���-�3 -� �:��:�^I `� <br /> O H� �__c_� -- <br /> qpplieant Mailmg Address Cily Zip Phone <br /> � no � <br /> c�� � «��� ( r' }"" �j <br /> z H Describe Proposed Work � <br /> a H� ----- — <br /> t" H H � <br /> d �n � i <br /> O �� <br /> � ( n S� �VV� . <br /> � � �r Proiect Address lit knownl _ � ZS ' 4�' — H i � <br /> z H C�n � <br /> H O C� Atlacl-, lour In)copies ol plans b�proposed vrork- �raw to scaie antl note Ihe lollowmg as applicable: � <br /> o Preperty Lmes • Cen�erhne ot st�eel � <br /> • Oul�ine znd dimcnvons ol all eaisting;ina • Indiwte North <br /> proposed strucWres on the lof • Show any proUosed grading chanyes <br /> • Ezisling and pronosed u�JdieS • Sttov+nteesur�m9ni5 /y� . <br /> tlr <br /> � � DO NOT IVRIT[ BELOW 7HIS LINF: � <br /> PFRMIT CONDIT�ONS <br /> �� 1.AI!calls lor insFeclion shall be matle 24 hrs.ui advance-phonc 259•881 O. �q <br /> �� 2.All work Shall b:pedormed in acr,ordanCe wilh lhi5 permit nntl curtrnt City nl Ece�e��Design ond Construclion ♦ <br /> Standards and Specilications. <br /> 3.Call Locution Under9round Scrvice 48 hr.:.bcfore you d�g.TOLL FRE[ NUMBER 1•800•424•5555. � <br /> '` � <br /> -- o <br /> �_ <br /> i_, �, <br /> � _ � <br /> �i_ � � <br /> �_ �' <br /> � ACKNOWLEU�EMENT OF CONDITIONS <br /> �� ��� The tmde�siOnod ownr.r/appl�cant hereby e9rces to hold and save harm� <br /> �--�- - Iess the Ciry ol [veretl irom any and all claims tor damages, costs. I <br /> '�1 i <br /> � exaenses, or causes of achon that may anse be.tause ol installalion � <br /> � �. y�� L�/ I/�/��Ci and mmmenance ol R�e �mprovament or olher ri3ht-ol�w2y use hereto � <br /> �YC�Q �� {v�L applir.tl ior and lurther agrees �o remove :ame upon no�ice trom �he <br /> ApProved for CLpnstructio._ Date �� ;���+ �,. eplac.. � ��P�operty damayec Uieieb�•. <br /> i/ ` <br /> ��'y/ ��l _ � <br /> � l-i'-s� _ �,�ir 2 � <br /> FINAL INS4'ECTION Dale � <br /> A�P�oved as Constructed Signature o�APPIic: nI Date <br /> WORK AUTHORIZE THIS PERM�1 MUST BB STARiED WITHIN <br /> Ir�vernl( PUBLIC WOR�CS DEPARTMENT 180 DAYS OF UATE PERMIT IS ISSUED F�'D THEPEAFTFR IS TO <br /> � 3200CedarStrer.t BF DILIG[NTLY PURSU[D TO COMPL6�ION THIS PERMIT MAY 9E <br /> EverelL WA 98201 CANCELLED BY THE CITY UPO� 4h1 STGPPi�GE OP WORK ON THIS <br /> Phone:259�8810 PROJECT O`✓FH 90 DAYS D�RATI�'JN <br />