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<br />PUBLIC WORKS PERMIT
<br />Print or Type Only
<br />Own'Y r�►�nv
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<br />MaJmg Atldress
<br />M3�b0(� NOtllP55
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<br />Desr.rlbe Proposed Work _ f�oJi �J ��_� �__�
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<br />Pru�ocl Fticresslil known� / G �/ H Z�'— /ClJ- �,( .�W.
<br />Atlach luur 14� copies ol plAnt. I r p�oposed work � Draw In scale anA nole Ihe tollowiny as apPl�c:�nit�
<br />• f'roperly Lmes • C�en�erhne al slrer�t
<br />• Ou�hne pnd dimensions ol nll e.�slmg enA • I idir.ate Nor�h
<br />prpposed slructures cn Ihe �ot • Srow eny P��+n��si�d yrnAinq �.nHni7rs
<br />• E�isling Bnd p�oposetl utihhes • Sho.: �iensurPinrnis:
<br />PF f�M1T CONDITIONS
<br />1 All calls lor insp�3chon srall be mede 24 hrs. in ad�ance � phone Z5Q•8$�0
<br />2 All wark shall Ue pr.rlormed in eccordence wilh Ihis permit end curreN Gity ol E.��rr�; De,i9n and Construr,tio�
<br />Slandards end Specilicntions.
<br />3. Cell Location Underground Sernce 4B hrs. be!ore you Aig. TOIL FAEE NUMBER 1•B00•�{24•Sb55.
<br />� A� CiYANC� /,U %nE DF'il/Ecc/f�f/ �c�tAi�n�/ i'YICYi
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<br />s iY��P Ciry sT,��EE-rs �«sr�✓ <Ir 9« T�m�s.
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<br />Approv . l,nr Con9�ru lion ' / De�e
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<br />fl AL INSPF(. 10 � / D�
<br />ApP�oveA as ConslructeA �
<br />rvrn•tl PUBLICWORMSDEPARTMFNi
<br />� 3200 Cadar Stroel
<br />Evere�L WA 98201
<br />Phone :59-flB10
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<br />�CKNOWLE[)G[MEN1 OF CONDIiIUNS
<br />The undersiyneA owneUapplicnnt hareby agrPNs to hold anA 9ave harm�
<br />less the City ol Eve�elt Irom any anA all claims lor Aamages rosts,
<br />etpCnses. ur causP.s ol nct�nn Ihal may arisr hecau9� o� instAllHhon
<br />and mainlenance ol Ihe cnprovement oi o'he� nyhbobway use liere�o
<br />�pplied lor A�A iwther agrees to remove ::nme unon �rotir.e Irom Ihe
<br />ICily and lo replace pubyc.pc�perly damep�d Pre�eby
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<br />Si{inaliue ol Applicant DBIe
<br />WORK AUT,�ORIZED BV ifIIS PER4tlT MUST BE STAATED WITHIN
<br />190 DAVS OF DATF. PEFMIT IS �oSUED ANU THEf7EAFiEH IS TO
<br />BE DILIGENTLV PURSI�E� 70 C:)MPLETION THIS PERMIT MAV BC
<br />CANCELLFD B'v TIiF CI�V UPON ANY �rOrPACF �F WORK ON T�nS
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