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f /4".�.4 l_ <br />Date �% �'� ' �.f �� � � <br />APPIi�aUon For 1 �� � � � C�� k, <br />PUBl.iC WnRKS PERMI'� �� <br />Print or Type Oniy <br />f`�e�e. w.nwe ne.m.i � _ Q '✓. -�` � <br />B�CO Onp� • __' _'___' "" <br />PUM¢ WoiMnfwp ---�J.� ���.. <br />r�i.i r„ t � c. <br />i r.e ann� � n�, r.nn S___� <br />n�.... ��,� S [—� - ___ <br />� 37 i S/ ,'✓�-,?��� r/lil /1 L< u-.T•� <br />Zi���� T/+'/ � c-n�� i,Z �=�.�,�•�,_-_:_��_�+ 9s�� ., 'H �-3c 3,_ <br />__�_ — --- --- - <br />OWIICi MeihnyAddirSS i,dy /ip Pl�nnr <br />.S/i /�.� r, <br />------- ---- - - - - - - _ <br />_ _ _ ___ <br />AppliC2n� Madm�i Addn=��,s Cdy ?ip Phonr� <br />De9Criba Ptopo9ed Work ����/�IGG S��G- SG��"t�.'�� y__/`-��/� _ <br />Fk T�•�c si�l/�C r �=fi'/7l/cy .%�'-�,.�c <br />�2«.��t- iitJ cC��'!� S'E�J'v�i _ � f� <br />Project Address li1 known) ��"'� "` ;� / <br />�� � - io� y� <br />��Ilech tour 14) copies ol GIenS lo� propu9e work - Dra�v to sr,a e end <br />• Properfy Lines <br />• Ou�lira qrd dime�isicns ol nP exislin� and <br />pronosed :t��UclUres on Ihe lol <br />e Eeis!mg xnd proposeJ utild�es <br />the lol�owln{� as epPliceble� <br />• Cen�erlmi ol Streel <br />• Indirale Norih <br />• Show nny propoSaA 9rqd�n9i.nanqrs <br />• Show measuremenls <br />�� �.Q�.�— <br />����p� <br />PERMIT CONOITIONS <br />t All cells for inspe�lion sheh Ge mede 24 4rs �n aAvanra � phone 259•881 F <br />2 AG work ahall be perlormed m e�.corAnnce wNh fhls permii anA rurrent City � cver��lt D�:si�n and �onsiriiction <br />Slan9ards end Speclficalions <br />3 Cell Lccetlon Untlerground Service 4B 1•,rs. belore you diy TOLL FREE NUMBER 1•800•424•5555. <br />J� i�fT�G L �'r� S.—,t� G u/ (, ; c'.� �o v�.� <br />� <br />S �"�' /9ff:�"L <z�_� /G' fJii) _ <br />� � ���i�i� �-*^ -��_ c''��%o-e �c ,��- ; i <br />u <br />�,� ; T�,�-�n �� •i �.. ��� U�a,,�,F�., 'y�,� z� <br />-�=-�/ �,/ ��J _ <br />- �i- 7` c� .. {��'-�/ <br />ApPr� lor Conqtrueli�n , � `� a�U e <br />, <br />�� — � !gy u! <br />FINAL IIaSPECfIpN Date <br />Apprnved as Construcled <br />e�ve•rrit PUBLIC WORKS DEPARTMENT � <br />� J2M Ceder Slreet . <br />Everell. WA 98201 <br />Phone�.259�BB1.5 <br />� <br />.L/t'i I <br />nCkNDWI f OGLMf N1 i�i CONI) ill1NS <br />W <br />� <br />_ / <br />�LJ <br />/rA <br />V/ <br />0 <br />a <br />1 h�� undt�rsu�nCU nWntvrapPhrAni hi�irhy ayrp��� R1 pnld a�tt� tiH�r�'��n m <br />Irss Ihe Gly o1 Fverett Ircm �ny and all Cleim;� lor dHmpqes ��s��. <br />e�pen9es. n� ceuses OI eCIIU� �h01 mAy 8119P, bHCAuse OI In51811Flhr•r <br />xnd melntenance ol Ihe Improvement a olher n��h��of�wey use hrreio <br />apphed lor enA lurlher egrees �o remove some upon notice Irom u���� <br />Ci1y end �o replqce P��nhc properly demnged Ihnrnhy. <br />T � ,.�, /�•�...�, <br />Si nalure ol Applicant Date <br />WORK Al1THORIZED BV THIS PERMIT MUST E�E STARTED WITHIN <br />180 DAVS OF UATF PERMiT IS ISSUFO AND 7HERE�1FTER IS 10 <br />8E DILIC�NTLY PURSUED TO COMPL[11C1N T-�IS NERMIT MAY BE <br />GANCELLED BV Tr1E CITV UPON ANV STOPPAGE OF vVORK ON THIS <br />PROJECT OVER 90 DAVS DURAi1r7N <br />