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� <br />Date.2�11-� <br />APOGteliOn For <br />�PUBLIC 1M1'7RKS PERMIT <br />Print or Type Only <br />2 <br />AtlAiess <br />� — <br />AppliCen� Mailin9 AdAress <br />/ / <br />�ty <br />� /. �'� a. `' <br />( Pubiv WorMe Peimil • �_ � � jj <br />n�n�� nnn� � �� � -/. � ?`� <br />z�i, <br />Pu1.L( WUrM�Fne ! <br />1(11AI lew `� .. ...-_._ ... _ �. <br />lrts RpYI 4.�. Va�i1 S <br />Pvuv�.ro�,.. S __�. _ ��__ <br />Giiy Zrt� Phon�a <br />� Z (�� ,/� /� <br />Deacribe P�oposed Work �...QL�1� iru�?� _„1T�f�1-7=.A-Jri_ - <br />Prolecl Address lil knownl ���-��+���1� �--- <br />AlteCh IC r(4) copies ol plens �or proposed work � Draw 1.. scnle nnd nnle tne �p9owing ax appl�cnhb� <br />• Property Llnes �9 Centeil�ne ol sireet <br />• Oulline and Aimensions ol qll e�isl�n9 an�1 • Ind�rale Norlh <br />proPosed struc�iues on tF. � lot • Show.:-v n�o�osed yra�lini� cha��q�,s <br />• Exis�mg and proposed ulihh^s • Show menswemen�s <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shall be made 24 hrs. in advence - phone 2$9•8810 <br />2. All work ahell be peAormed in eccordance with this permit end r.urrenl Cny nl I�.vi�rell Desqn and Construction <br />Standerds end Speclfications. <br />3. Cell Location Underground Service 40 hrs. befo�e you dic�. TOLL FREE NUMOER 1•800•424•55$5. <br />� ,��•�,o �',ry S�i��E�s C«..n.✓ �'r 9« ���,c _r <br />�._: S_ �.S'..o�«pc.r Gv,ea ¢ ��u��,c %e� .✓,�-�✓ y.�.� ��,d,y,����,�! <br />'},`�.� t '� �L' Ti/£M f'/,'9C[ � /�c �.9�,e'E <br />� q,y ��,��� <br />���YA�'F.� <br />''. ,(�j��/ %,✓i �i�%�[ ',"!..r- 'i . <br />,. � <br />�__/�� / �L ��� R'�� � BB <br />Appro d lor Constrlction ��P <br />i <br />�y � l� - ) � <br />FINAL INSPECTI Dnle <br />ApprovuA as Consiructed <br />rvNrrtl PUBLIC WOFlKS DEPART�fEN7 <br />e 32���ada�si�ee� <br />fvoretl. WA 98201 <br />Phone.259�8810 <br />ACKNOWLFDGCMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />� <br />� <br />� <br />Y/ <br />O <br />a <br />The undersi�ne.A ownevapphcNnl hereby a9�ees to hold end sxve herm- <br />less the City ol Everell Irum nny and all claims lor dameges, co515. <br />ezpenses. or cnuses of ar,Uon Ihal IO�y Bf19P. h2CAU5C OI installution <br />and mainlenpnce ol Ihe improvement or other nght�o4wny use hNrelo <br />; flnni�ea io� and furlher agreta lo remove seme upon nnhr.r Irom Ihe <br />�City and 1 replace puhl . prope�ry demeged Ihe�eby <br />\� \ L 7 � a <br />\� sc.� � . / - �d-�.�--G � <br />Si9n e ol Applicanl Dele <br />WORK AUTHOR12ED BV THIS PERMI7 MUST BE STAf7TED WRNIN <br />I80 DAVS OF DATF PERMIT IS ISSUED AND THEREAFTEF IS 10 <br />BE OILIGENTLV PURSUED TO COMPLETION THIS PEHMIT MAV BE <br />CANCELLED BY iHE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION <br />