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oe�A✓� -a - �� <br />I Apolicetion For <br />� �UBLIC WORKS F�ERMIT <br />Print or Type Only <br />j-1 - c.'�9 ' r'�i - <{ <br />o�oi , w�,. � vs,mn • � 7. -/ <br />Bina peo� � _�.__- <br />v�ee� wo,�� r.e <br />.o�.� F�, s <br />Leu �p0� fea PpU i�_ <br />Bsi�nce0w � �Z� � <br />�`� S� �VEr'E—tt �#ii <br />Zip Phone j.�1' 21 �Z <br />�1 ChLL � hO n.11s'-' �-- - <br />Apphcent Maihng AAAress C�Iv Lp Phone <br />DeaCrlbS Proposed Work ��� �'�a7�_�_� — _� � � v ��i`��� i _ _ <br />/ <br />P�olecl AAdress lil knownl !�T�—�t�' ��T SF �-��r� � 1 _ _.__ ____ <br />Attach lour 141 copies ol plens lor proposed wo�k � D�nw In scele and �ole the follow�ng as epplir.eble <br />• Property Linas <br />• Outline end dimensions ol ell eMiStiny and <br />pioposed Slrucfures on the lol <br />• [nis�ing anA proposeA ulihl�es <br />• Ger�erlinr, o� shr.e� <br />• InU�cale No�lh <br />• Show any proposeA grad�ny chany�rs <br />• Show measurr,menls <br />PERMIT COND�TIONS <br />i All cnlls lor Inspeclion shall be made F4 hrs. in ndvxnce - phonF 259-eei O <br />2 All work shell be parlormad in pccortlnnr,e with Ihis permll and curtrnt C�ty ol Everr,ll Gesipn and Cunslruchon <br />SlenAnrds nnd Specilicehons <br />9 Call LocaUon UnderqmunA Servir.e 4B hrs beloin you Aig TOLL FREE NUMBER i•8OO•i:'14•S5SS. <br />� <br />, ��' <br />.� - ._ ..____._ . .__ ___.___ <br />�;� , 'i <br />' <br />`� h <br />tl�� Bc�_— — �`-���L <br />Aunrn t Consnur. u�n __ - -� � <br />/ /��. <br />/ '/ <br />�<.t -t_• -f/_ <br />�TIni�INS�'f�(:110 �'� �" USI� <br />�PP���v��d ��ti Cunstiur,tetl <br />�PUBLIC WOPNS DEPARTMENT <br />3200 Cedar Slrqel <br />FvPretl, WA 9H:01 <br />Phone 259�NBIp <br />AC,KNOWLE�GEMFNT Of CONDITIONS <br />7h�� undrrsiqneA owner/aUpliCan� hereby agrees lu huld anrl save h,inn- <br />IPss Ihe• Gly ol EvFrnll from nny and all :;laims lor dnma��rs ensis <br />eMpenses or r.ause.s ol ar.hon ihat may ense bnceuse ul instalielion <br />9nd mninlena��cr n1 Ihn impiovement or olher riyhl�of�way us�� hernln <br />apphntl In� and lurthrr agree5 lo remove bema upon nM�re• Pom Inn <br />City and to r��pl:�re nuhlir property damaged thereby. <br />� /6 <br />% �� _- � �- �r / __ <br />Si .Flture OI APP��cTnl Dat�• <br />WORk 4UTHOH12FD 8Y THI$ PERMIT MUST BF STARiED WITHiN <br />190 DAVS OF DATE FERMIT IS ISSUED AD:D THEREAFTER IS TO <br />BC DIUGENTU' PURSUED i0 COMPLE110N. THIS PERM17 MP.V BF <br />CANCELLED BV TNF. CITV UPON ANV STOPPAGE OF WORK ON 7�' <br />PROJECT OVER 90 DAVS DURATION I <br />