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Date��,��- � <br />--.:.�L� ' <br />Apphcalinn Fni <br />PUBLIC VI/ORKS PERMIT <br />PriM or Type Only <br />Apphcant <br />' �� : �(J�� � <br />Mxilinq AAdress <br />/ � _ <br />,,,,�.��� w�,.� �,a,m, � Y ? � �. <br />:.j' � } � �'{ <br />u�n,� o�r� . .i ����.1 �SL �'�� <br />�..,�;�.w,�;�,�.,. s - <br />,��.��.. — <br />�,,.���,� �.. �„,� s <br />, � <br />Aa�a��«n,,. S �-�1__ <br />, �, ' l <br />';Z�_� 1 l l �ti 1��_ f <br />z�e/ Phonp <br />' ) �7� � ' � ��1`�.t'i� <br />DescnUe Proposed Work ��.t.� . _ � � � —� ----- <br />7 <br />Pralect Addresa UI knownl < < ^ --� --� � <br />At�Och lour IA1 cop�es o� plans �or proposed worw � O�.w. In �c;Jc :ind no' • Ine lollowing as apphc;�l�ii� <br />� �fO�P��Y I.IOP.S <br />• Oull�ne and d:mpnsion5 0� all entilin�� .�ntl <br />prOpr,Pi1511UCIW@s On Ihe Inl <br />• E n5�mq anA proposed u�ihbrs <br />• Grnlerhne o� slrert <br />• In�icnte North <br />• Shnw pny prnpnse�d yrnd���y rhai�9es <br />• Shuw n�rasw��m��n�s <br />IHISI.INf <br />PERMIT CONDIT�ONS <br />1. All cells for inspechon sha�l be made 24 hre. in advanr.e � pnone 259•88'i i� <br />2. All work shell be Fer,rmed in eccatlence wlth ihis perm0 and current City a� Everell D=siyn and Cons�ruction <br />Standerds end Specilications. <br />3. Cell Locelian Underground Service 4B hre. be}ore you dig TOLL FREE NUMBER 1•BOO•424•5555. <br />�• <br />n u <br />� -4 ��.-Ati�� <br />_",r'ALL-`� <br />hc r, �, Pr •, [3� N i f�;t7 l>/� 'l-::� <br />1�, C'' Ir .�'1�r k- r,_,r�e= ,-,i = D,% -J <br />�� <br />���—� -- — <br />�� �V � <br />- -i _.S�s4i._� f�-`�� _�� � �= f <br />ApProv��Construc�ip Dele <br />nN � i l crio��(�`___r'_��!' <br />Anp�oved as Con9trudr.d <br />t•�rrrtl PUBUG WORKS DEP.�RiMENT <br />� 3200 Cedar Streel <br />Eve�elt. WA 99201 <br />Phone�. 259�8810 <br />ACKNOWLF[1GEM@NT QF CONDITIONS <br />� <br />• <br />J <br />� <br />N <br />O <br />� <br />The unders�gneJ awneUnpplicTnt hereby ngrnes to holA qnd seve h;n m <br />less ihe Cfl'• o� Evr.rpq Irom �ny en i nll daim5 lor AamageS cnsv; <br />P.wP0�5CS. O� CAlISCS 0� �CI�O� �hPl Rldy nnse becnuse ol IOSIBIIBb���� <br />Pnfl AIAin1En20f.0 t�� Ihe imryovement or other nghl�o4way use henan <br />apphed for end Iwiher n9rees �n remove seme uVon notice Irom m�� <br />Cdy and lo replaCe puL t pronerty d3ma7eA �hereby. <br />� <br />t�- <br />Sic alw . ol Appli .a Dalr . <br />WORK FVTHORITFD BV fH15 PERMIT MUST BE STAHTED WIIHIH <br />780 DAVS OF DATF P[RMIT IS ISSUfD AND THEPEAFTER IS i(� <br />BF DILIG[NTLV PURSUED TO COMPLETION THIS PERMIT MAY Pf. <br />CANCELLED BY iHE CITY UPON ANV STOPPAGE OF WORK ON 1 H6 <br />PROJEC7 OVER 90 DAVS DURA710N <br />