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Date_�].J� o �' <br />ApU���ai�on FOr <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��uNirWorw� Pnrma • <br />ni��� Depi � --_ <br />PuoecWerM�Fae ` I �_^ <br />1nln���� ��K� <br />I v�a <I�1�' ! nr f�.!.i1 s — <br />0.�'. ...fin .S __ __ __ . <br />_�q,,,n 1�ROCKmA�a a?yo9 di�F Sl. �=�e�rt+ c..�A 4.C�o1 �5�2-�y9� _ <br />Ow�er Madmg AdAress Gdy l.�p Phonr, <br />APPhcnnt <br />Med�ng Address <br />Deec�ibe Proposed Work fq�l <br />iIY Zip Phonn- -�� - � <br />Projec� Addreca 1il known� �� �n6 �` U, S.F. '�JFRirir LwJ n __ <br />Allnch lour (4) cnpiea o� plans lor pioPosetl work � Draw lo scnle and nole Ihe �ollowing ns nppl¢able <br />• Property Llnes <br />• Ou�line end dimansions o� ell e�islm9 and <br />pwposed structuras on the lot <br />• Ezisting nn� propoeed ulill�ies <br />PERMIi CONDITIONS <br />• Cnnlerline ol sireet <br />• Indicele No�th <br />• ShnW eny ProP�Sed (ar�dinq �han9rs <br />• Show mPflsurPmen�s <br />1 All r.alls lor in9pection 9he11 be m2tle 24 hrs in advence � phone 259•881 5 <br />2 All work ahall be perlormed in eccordance wdh thls permd and cunem City ��I Ev��mtt Drvqn nml Cnnslniction <br />Standarde ertl Specificetlons <br />3. Call Looetlon U�iderground Servir,e 4B hre. balore you dig TOLL FREE NUMBER 1•800•424•5555. <br />.y� � /�n)n/c j - .'>'c.�l�` <br />/ <br />. tj � <br />FINAI INSPECTION \ <br />ApProved as Conshuc�e <br />rv��rru PUBLIC WOFKS DEPARiM <br />� �.;200 Cednr Slreel <br />Fvere�t WA 9fl201 <br />f'honn :595P15 <br />Da <br />Cc iQ�—=^'e,' S�c �.��'Cic C.-- <br />�LM.N(1WLEDGEMFNT OF CONDITIONS <br />W <br />a <br />_/ <br />� <br />O <br />H <br />� <br />O <br />a <br />1hr� undritiup�oJ owneV9pphLenl heraby Bg�E0810 hnld ni�A sav<� h,tnm <br />I.�ss Ihr� Gny ol Everetl Irom A�y nnd all tlaim5 lor Aamages � nsls <br />�e�penses, or causes ol ncGon ihal may en5a hetause of mslallnlinn <br />��d IiIPiMP.OP�CC O� �hP �rtlpiOVETCfI� Of O�h2f /IfJhPO1�W8y use h��r��lo <br />�pphP,A lor �ntf mrlh��i �qrees �o rempve 5ame upon noiir.p Irom I`ie <br />City and to «�P�;�cr publir. proparty dnmaped I�ereby <br />J � <br />_ Iur ol Ap , nl ` �D���` . <br />WORI( AUTH IIED BV TNIS PERMIT MUST BE SiAFTED WiRnN <br />180 DAVS OF DATE PFRMIi IS ISSUED AND THEREAFTER iti tp <br />BE DIL.IGENTLV PUFSUF.D i0 COMPLETION THIS PERMIT M�v 9E <br />CANCfI I FD PV THF CITv UPON ANV SiOFPAGF OF WORH qN 1Hi5 <br />f'RnJf�Cf f�VFR VO D��S I�UfiNIC)N <br />