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Date 1/3/'i5
<br />AFP��cationFor 1�: �'OSTING
<br />PUBLIC WORKS PERMIT
<br />Print or Type Only
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<br />Puni�cWert�fee `
<br />fau� Fee
<br />Lese �DP� Fea PeiU s
<br />Brvnce Due :
<br />L b L buildcre lUTl1 L'v�iprac�. wy SSII�h LO-1"r'1" _
<br />Owner
<br />Malling Atldress C��Y Z�P Phone
<br />ta�r[y !'ond
<br />Applicent
<br />Describr. Proposed Work
<br />Pro�ec� Add�ess lil krur,vnl
<br />Mailing Address Gity Lp Phone
<br />N�r+ howc - E�eic 200
<br />72'2 IOOYh P] SL
<br />Lot 2, Short Flst hb-yU
<br />Atlach lour 141 cop�es M plens for proposed work � Draw to scale antl note t��e �ollowing ns �pplicab�e�
<br />• Prol%���Y Li�es � Genterlinr, of slieet
<br />• OutGne anri d�menswns ol el� ea�slinq anA • Indlce�P Norih
<br />proposed sUuctures on the lol • Show any proposrA g�eAinp changea
<br />• i:risting and vroposed utildies • Shnw measurements
<br />PERMIT CONDITIONS
<br />1. All cells fo� inspeclion ahell be mede 24 hrs. in edvance - phone Z59•88/0.
<br />2. All work shell be pedormed In eccordence wllh this permit end current City of Evoieu Design v��a Conatructlon
<br />Standerda end SpeciOceliona.
<br />3. Cell Location Undergrrund Service 48 hra. be�o�e you dig. TOLL FREE NUMBER 1•800•� �24-5555.
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<br />. � � � " " ' A KNbWFEDGEMEN1 GF GO�lNTIQNS
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<br />ThP undersigneA owner/applicent hereby ap�ees to hold enA sxve I.arm-
<br />— less ihe Gdy ol Everell Irom eny and ell claims �or Aamapes cosls
<br />e�penses. or causes of eclion ihal may eriee beceuse ol Installalion
<br />and maintenance of �he �mprovement or olher iighhol�wey use herelo
<br />apPned for and lurthri �grees to remove 68me upo� nohce �rom Ihe
<br />C�ty onrf to �eplace P��hhc prope�ty damayed �hereby.
<br />�PUBLIC WORKS DEPARTMENT
<br />3200 Ceder Slreet
<br />Everel:. WA 98201
<br />Phono� 259�B810
<br />$i4����ure of AppliCanl DAIe
<br />WORK AUTHORIZED BY THIS PF.RMI1 MUST BE STARTEG WITHIN
<br />1B0 DAVS OF OATE PERMIT IS I�iSUED AND THE(iEAFTER IS TO
<br />BE DIUGENTLY PUR57ED TO COIdPLETION THIS PERMIT MAY BE
<br />CANGELLED B'i iN[ CiTV UPON ANY STOPPAGE OF WORY.ON THIS
<br />PROJEGT OVER 90 DA1'S DURATION
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