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Date�1�$5 <br />AppliCetion For <br />PUBLIC WORKS PERMIT <br />Frint or Type Only <br />n�M�cWorwe.urmn•p �-�T'� ✓ ���_,_ <br />0'ea �eal a OS / /�i�(O� <br />-�--- <br />vunirc Wo�M� Fw � <br />imel Fea <br />L•a��o01 fa�P�iA � _ <br />eni��r� Due � �� r' <br />� �// b'' <br />y�- s�� <br />� �� _� rC �� --Q��.uZa _3rL 1�� .�'E �,�o�p�}�G/�- 9��5L— <br />Ine� MaUing Address Cily 2ip Phone � <br />sQ N1.�2 <br />,� Appllcent MaillnqAddres6 Cih Cip phone � <br />Deectlbe Proposed Work <br />Projec: Addreee �il known� � <br />— ici-� -- <br />Allach I.ur (4) copiae of plans lor piop�sed work � Drew to acele end nolr. Ihe lollowing es app6cablr <br />• Praperty Lines f;entorline ol streel <br />• Outline end dimenaions of ell existing and • Indir.ate Norih <br />propo6ed s;ruclures on the lol • Shaw eny pruposed gradinq chxngr.s <br />• ExiaNng end proncsed utllitlea • Show maesmnmen�s <br />PERMIT CONDITIONS <br />1 All celli lor mspe^.bon shall be mqtle 24 hrs m ndvence � nhone 259•881 s <br />2. All work ehell be performed m nccordxnr,e wilh th15 permit and cunent Ciry ol Ev�re!I Oesiyn aid Cnr.sPuchon <br />Slenderds end Specilicetior�s, <br />3. CeL' Loce!ion Underg�ound Service 48 hrs, belore ymi dig. TOLL FREE NUMBER 1•800-424•5555. <br />E <br />� d/ ��i«. u/O.f'f i..C� To Onnic Tiii7T �tiY'i�� c 1� 6'c cY.t <br />Tf/E �L'Ai.✓A!•F Sw4lE A.!'EA c'.t/ F�l57 f�..'n�E.t'T� L�Nf . <br />,�. `l'en�ti•-� b� Ts/f LUT iS T� i+^F 1�nNE Sa AS <br />itlOT TL jn��e c T TiF SU�(', �vivNl.Ln/c= ;�� j <br />i . �ld UG i '%'(+d n.S( /: /l17.<�.' id ( i //� _ ,. � <br />� p r <br />24.. / c�� - ��- ;/ S� - ti'• <br />Apf roved lor Consl�uction Dat= <br />� � �sl <br />FINAL INSPEC ION �e <br />Approved ea ConelructeA <br />evrrptt PUBLIC WORKS DEPARTM�NT <br />� 32J0 Ceder Streel <br />Everelt. WA 98201 <br />Phona�. 259�8815 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />nCKNOWLf_DG'_-MEM Of CONDITIONS <br />lhe nnUoc;iynod owner/apP���'Ant hereby egreee �n hold nnd snce �-�anm <br />I��ss ihr C�ty ol Evere'� hom eny xnd �II claim! br Jamagus, r.os!s, <br />e:.pPnSeS. ol CBUSCS 0� OChOn �h61 RIP)' 0119C bP.CBIISB O� IOS�BIIti�ipn <br />anA mamlenence ol ihe improvamenl or other right�ol�wey use hr.rHo <br />app6rd lo� antl lurt r a�rees lo rnmove seme upon notice Irom Ihe <br />Cit ��rl �o replac ic property dnmegatl thareby. <br />,. . <br />S�i�nelwe ol APl�hcaN `�—��Dete <br />WORK Al1THORIZED BV THIS PERMIT MUST'.�E STAR;ED WITHIN <br />189 DAVS OF DAiE PERM? IS ISSUED AND 'HEREAFTER IS •O <br />BE D'LIGENTLV PURSUE� �U COMPLETION. TNIS PERMIT MP' <br />Ct,.`:CEI.LED BV THE CITY UPON ANV SiOPPAGF UF WQqK O' <br />PROJECT OVER 90 DAvS ��URATION <br />