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Date /� d <br />qpplicalian For <br />PUBC,IC WO�K� �ERMIT <br />Print or Type Only - � <br />PubL[WaMaPe��/ � //� � �—� <br />oma oov�.. �=-- <br />�ublicWorbFea S <br />Total Fee <br />Lesa AOC� Fea Paitl S <br />Bala��e Oue $ <br />Owner <br />�,.., _. �zU-779'� — <br />� <br />Prolect Address (if known) - " <br />Attach lour (4) copies ot plans for proposed work - Draw to scale and note ihe lollowing as applicable: <br />e Properry Lines � <br />•Outlineantldin .,�C��d('��atnmcriAWort6yo(I:crryConxidcration" <br />proposed slruc ��� <br />e Exisling and pr -7 <br />WESTERN UTILITIES SUPPLY C0. � / � <br />PERMIT COND <br />1. All calls ior ir <br />2, All work shal' <br />Standards ar <br />3. Call Locatior <br />Watenvorks 8 Sewerage Supplles E�� onor+e <br />Sa�90MI0AVF 50� P.O.BO%IbO1 <br />P.O. OOC ]SY � SPOKANE, V!A 99=>> <br />SEAT7 LE.1NA 98124 5�5-1 ]^G <br />io:'%O:i <br />1 � i, <br />jL�� %���J�iL' L.�%�:�'/,�= S <br />�����/���% �EG�Ui,� E� <br />�� - <br />gS���,�'- �� — %'�- -?c <br />, :� i i -r � '_`/ <br />Approved lor Construction SEATTLE <br />1-800-562-1065 <br />FIN.4L INSP <br />App�oved as Constructed <br />everett PUBLIG WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98207 <br />Fhcne'. 259�3E31` <br />TOLL SPOKANE <br />FREE 1-800-572-0531 <br />�changes <br />sign and Conslruclion <br />D-424-5555. <br />■: <br />iEMENT OF CONDITiONS <br />anl hereby agrees to hold and save harm� <br />any and all claims tor damages, cosis, <br />n lhal may arise because of installation <br />s to eemov��,same u P'on not ce Irom ihe <br />perry damaged lhereby. <br />Date <br />Date <br />Signature ol Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHI <br />BE DIDLIGEtJOTLY PURSUED TOICO P�LE�TIGN.DT I �EPERMIT MAY O <br />GANCELLED 6Y THE GTY UPON k�dY STOPPAGE OF �"JURh ���J THIS <br />pROJGCT OVER 9u Di1YS DURAT�UN� <br />