Laserfiche WebLink
oate�� �" • <br />AppliceNon For <br />PUBLIC WORKS PEl�MIT <br />Print or Type Only <br />/_- . <br />i : <br />_ �_.�'��/I�U�C G i�,t � <br />Ownc� <br />�Jf� J�., <br />no�u�e�� <br />/� ' / <br />� <br />� G-��c:c' //� i <br />Addreas Clty <br />Addreas Cl�v <br />Pub�¢ WOIF� P11m1� • � Y �_,�� � <br />Pltlp Oapt � 1 � / '� <br />puni�c wnre� fee ` <br />Lolr,� Fee _ <br />L�m �pyl Fae Cpd { ___ _ <br />` .~�1�� <br />Bsienn Due <br />,� — <br />r, . ' <br />/x l�,/U_ i ���1 -• ,� I <br />up <br />Zip Phone <br />i"7 •� <br />Oanc�lbe ProPoeed Work �. �> �.� / � �� ( � { �. vJ _.�� !� . , , �� ' <br />_� <br />Pro�ect Addreea pi known) ��� — ���G'� /��� �, f'. <br />ABech lour (4) coplea ol plans lor proposad wcrk- Drew :0 9cele end note the following es aFpliceble� <br />• Pwperty Linea • Cenlerline of slreal <br />• Outllne end tlimanslone ol ell exlsling and • Indicete North <br />propoeed etructuroe on the I�t • Show any propos�d grnAing chenyes <br />• Exlnlinp and proposod ulluaos • Show measuremems <br />PERMIT CONDITIONS <br />7. All calls lor �nspection shell be mede 2d hrs. in edvance � phone 259-l3815. <br />2. All worF ahnll 6e per�ormad In accnrtlanr,e wlth Ihis permtl entl cu�rnnt Cily ul F:ve�relt Design end Ccnstrur.lion <br />StAndxrda enc� Specllicetions. <br />3. Cell Locetion Wdergro�nd Servite 48 hra. before you dip. TOLL FREE pUMBER 1•800•4Z4•J5$S. <br />�% .���i���,.�•. _i ., �,. i�: �i-: � in , . <br />/ � �..i . <br />•'�iOEn.dt� !.Y Cr <i A /y�r: .: /�i.!; n,-.' . . . . � . . <br />�NdCL /,�f �'�¢'i�G.�G� /�y. r,y� /i<�N[ic"dn-% <br />-`�, inaf A���n/•s� v�'S �'Heit �f T.h�v�_ C�n <br />�'rtir'� t�.cenvs'. <br />��� n.� .-� o.v T�,� c or .Ss�n. c rs'F ��,ve S�, •e.' <br />. . .i. , , 7f.� , .. ,. ,,. . , . , <br />/' <br />Approved for Construcfion Date <br />F!NAL INSPECTION Dete <br />Appioverf as Conetructed <br />rvwett PUBI.IC WORKS DEPARTMENT <br />� 3200 Ceder Sheal <br />Evaratt. WA 98201 <br />Phone�. 259�8815 <br />W <br />� <br />� <br />� <br />O <br />ACKNOWLEDGE' 12NT OF CONDITIONS <br />Thr midersiqnrtA owner/epplicanl heieby ugreas Ic hold a, �d save harm� <br />less �he Cdy ol Fvere I Iram any qnd ell cleims for damqyes, r.osts. <br />erpenses. or r.auses :t ecUon thTl OIPy OfIRB bCLeU92 OI mslellation <br />and mainlenence oi �he Improvamenl or other nphPo4wey use herelo <br />epulied for n�tl lurther egreea to remr,va eame upon notice Irom Ihe <br />City end lo replace public property dameBa� tharaby. <br />. � �/ <br />' f , . ��._ �� ` _ <br />l..'�',�-� / �.., i Ifl; <br />Signe W re of App�icenl Oale <br />WORK AUT40FIZEU 8V THIS PERMIT MUS'. BE STARTED WITHIN <br />1B0 OAYS OF DATE PERMIT IS ISSUED ANG THEFEAFTFR IS LO <br />BE DILIGENTLI' PUi1SUED TO COMPL[TION THIS PERMff MAY BE <br />CANCEILFD 9V iHE CITV UPON ANV STOPPAdE OF WORK ON THI i <br />PROJFCi OVER 90 nAVS DURATION. <br />