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PUBLIC WORKS PERMIT °`'�� <br />Puhlir. V:orks Permit tt <br />(;�ty of fveratt Pub'ir, Works Dep�rlment <br />1200 Ccdar strre; Bu��'dmg Permit # <br />I verett �ldn ���:�n1 Plannmg Reterence # <br />�q�5) �57-f3H10 <br />Pubhc Works Fee 5 <br />other 5 <br />r- OWIJER NAMf ANO ADDR[SS � �PPUCANT NAM[ AND ADDRE55�. <br />-- -- — <br />� <br />NGUYEN MIKf S TPML1Y <br />?3524151HAVE W <br />BRIER WA 99l%3h <br />PHONE: 425�ifi0003�J <br />'A% PARCEL ID p p�394400001000 <br />DESCRIPiION OF PROPOSED WORK: <br />SIIE RESiORATION <br />5��,�E SL1 OF PI 1.N5 S C 141U�C0fl <br />PHONE <br />SITE ADDRESS�. 1 `�� % `�HTI{ (�I SW #A <br />�or3v�oi�U��� � <br />�7i.� ��110' �`f <br />1410-007 i„� <br />n•%I <br />i � <br />5 40 00 <br />Ptf?MIT CONU�TIONS <br />t All ca'Is for ir,specLon sha!I be made 24 hours �n adva��ce <br />7 All work sl�all be performed in accordance wi!h the permd and cur�ent Cdy o' F�err,tt De�;�,��� and Construc'ion Standards <br />and Specdicabo�s <br />� Call Locahon Urderground Service 4b hrs befcre you A�g TOLL FREE NUMBER 811 <br />4 � lhe hulfer sl�ali be restored �s ind�calyd and ar�ended r�n Rn. i�:<trnat�a;� { Lm a:�{ ��.��d Oc�nber 29. 2014,Nc <br />i•eavy eqwpment �s aliowed m the restorahon area .— �-- �' <br />n r � �= m: i <br />6 � The sdt Ience must be installed pe� City s!andards as located on ttie approved pla i z. _ <br />-, � r:; <br />i; � An assurance device lor Ihe mai�lerance of Ihe rastorabon area must be suhmCled on a City issued torrn'�. � <br />.�vailable lor pick-up at ihe Pernu� counter The assurance must be no Iess than 10"/� ol the cost of the labor anA <br />ma;ena�s <br />� � An inspection is re�wred by the Planning Uepaitm�nt to verily Ihe above mentioned conditions 1�0vE� t« <br />lur th s permd and prior to issuance of buddmg �crmds Call Teresa Weldon at 425 757 7281 or em�i� �t <br />hse!don i� everPttwa �ov lo schedulr. a Plannmg insp^chon �•, �.. <br />� .. <br />NOT� 1H1.`,' f'f I1MIT Iti FOH l3Ul FfK I2ES10RATION ONl Y NU SI I E UEVf Lt�l'61[ N I W(7k��NALI <br />f'CHI ORMFU UN IIL IHL RUII �WG CONtiTRUC110N PEItMITti H�V� B[EN IStiUFD <br />!/ <br />� �,��-� - � � ,'3 <br />FIN�L INSPFCTION Date <br />App�oved as Constructed <br />�I <br />ill <br />��� � �CKNOWIhUGFMtNIC1FCONDITIONS <br />I he �,cdcrsnpied ownrzr�npplic.�nt hereby agro��s lo linld and <br />— - s;ive h.umless Ihr. Cily ut f-vciell imm any and all r,launs lur <br />damayes, costs, eepenses, or causes ol aclinn Ihal may arise <br />because ol installalion and maintenance of Ihe �mprovemenl <br />� or olher nght o( way us�+ hereto apphed for and `uhher agrees <br />�- In ir.move snme upun nntice Irom Ihe Cdy and �o irplace <br />pubhc proprrty amagedthereby <br />Signa�urc ol �pphcan D. e <br />1';ORK AU�NORIZ[D OY THIS PCRh111� ��tU57 flC SiAHTCD WIIHIN Ifl0 UAYS OF DATf PERP11i B ISSUFD AND IH[RlA11ER IS TO P( DII IGf �.ILY <br />PU�SUEf� 10 COP1Pl.EIION THIS PFR�41T MqY Hf 01NCLlLtU BY I Hf.l IiY UM1N ANY S10PPh(.f Of P;ORK O; IHIS VHOIf( T OVI�H 400AY5 DUHAI III�Y <br />�� <br />A�' � <br />