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Dale��fiS � <br />.1pPhcahon For <br />PUBLIC 4VORKS PERMIT <br />Print or Type Only <br />�'��I.I.r WOIF�P111mi��_� _.l'� <br />Pn�u Dept � _ rr��_ ' <br />�,;�.,�w�,.,.�,> �— <br />1mn� Pee <br />Lesa �ov� fee Pa+i s� T <br />U�J <br />a.�a��. �,.. a _ <br />��-1-� ` � --- - -- ------ --- <br />Apphcnnl M��Im�� Address Cily !�p Phone <br />Descn6e Proposed Work <br />n n h0� <br />Pro�ecl Add�ess lil knownl �� �� A � � � ��`�— �� -__- -- <br />Atlach lour �A� copies ol plans lo� proposed wmk � Draw to sr.nle and noto Iht �ollowing es apP�ica6le� <br />• Properly L�neS <br />• Oullme and d�mpnswns ol nll eiisting enA <br />proposed sirur,lures an Ihe lol <br />• E�isbng nnd p�oP�seA itlilities <br />• Ce,•�Arline of streel <br />• InAirate Nnrth <br />• S�mw any p�oPosrd Uo�diny rhnnyes <br />• ihnw mrasi.r�mFpis <br />HIS L <br />PERMIT CONDITIONS <br />1. All cells lor inspeclion shall be mnde 24 hrs. m edvance � phone 259•88�0 <br />2. All work shnll be perlormed in ecco�dence �vith ihis permit and r,unrnt City nl [verell D�vqn anA Canstrucliun <br />Standerds and Specificntions. <br />3. Cell Location Uade�qround Service 4B hrs. belore you dig. Tf1lL FREE NUMBER 1-800-424•5555. <br />� i�tiy �'/fA.dG� �N 7�c D,e���-.��t�,�f' �oc.,orc.�/ ir7v.rr <br />B� A��,eo✓•so 6fi T�/6 «i,�f�c a•v,�',rs riilrs�F�T��,e <br />S, /i�,�`'�s� Ci7t/ ST.P,s,�� s Ct E�J�/ /%i 9C ! Tin,� �( <br />��,����- 3 �yda <br />A�, rovyAli,i Lnr ,iruction Dete <br />l,�-._-? 5 :F�i <br />FI AL INSPECTI � - Date <br />AP��oved ns Construcled <br />rvrrrt� PUBLIG WORKS DEPARTMENT <br />� 3ao0 Cedar Slreel <br />Fvrrpll. WA OA?01 <br />Phnnr. ; �•�� N��n <br />ACNNUWLI_UGLM! Nl U� CONUIilUNS <br />W <br />� <br />� <br />� <br />C) <br />� <br />� <br />O <br />♦�A <br />V♦ <br />`�/ <br />a <br />I n,� uni���i� ��,nnr� pWner/B�pliCd�i hprP.by Bf�lPeS 10 h01d Plltl 6AV0 h8lT- <br />b�titi Ih�' l.+ly ol EvEfeli IfoT 0ny e0d dll CltlimS 10f dArtlpqCS. C09�r: <br />P.X{:C115E5. Oi C8115C5 O� BChOft IhBt TTy BIISC bP1:AU4B 01 If151a1�P.�b❑ <br />e/� A;neiMenAnce o� the im4�ovemenl or olher nyhPol-way usn herelo <br />ahpheA lof enA lurther e[pees to /emOve Eeme upon nohce Irom �hn <br />Cqy anA �o replace puhhr�Qperly damaged thereby <br />, ; � <br />,1, , <br />� , i , �.�,�L_ ,.,�-��.— <br />Sign�. ca� �� ' <br />ol Apphcent Date <br />WUrIK AUTIiOR17FD BV THIS PERMIT MUST BE STARiED WITHIN <br />1B0 DAVS OF DA1E PERMIT IS ISSUED AND THEREAFTEfi IS TO <br />86 DILIGENTLV PUR:'�UEO TO COMPlET10M THIS PEFMIT MAV BC <br />('.nNCFI'. FI� RY 111C CITV Uf (1N AN'f �T�)f'1'A.^,F OF WOFU<t�N THi� <br />i��:�.�lf� In;�ii.��il�:,�.��l�i�rynn��rl <br />