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i <br /> �I <br /> i <br /> ; <br /> Date�L�.Z a D ���,�,��� �„�,.,�o�..,,.,,� . 00 — Z�J <br /> Application For ' - �� <br /> Phlu 1��. <br /> P U B L I C W O R K S P E R M I T �°��;;,,,�p;�°° S -- -- <br /> trn+�ovi vr.rmn S <br /> Print orType Only � A��,,��,.o�� S �—�— <br /> _�Ly���im 1 tJ� �I D �C" �►2 � ��15 q�� <br /> Owner Malhng Address Ctly Lip Phone <br /> — — ——_ `�✓�S.��J i <br /> Applicanl MaiGng Address Ctly I�p Phone �I <br /> Describe Proposed WOrk �^---7�FK_ �,�T O`� __���_���C�L. � <br /> -- � <br /> Pro�ect Adtlresslil known) ,/�D� — �09 —�-l��___ __ __ � II <br /> � <br /> Altach lour 14) copieo ol plens loi proposed work� Draw lo scnle end note Ihe lollowing ns applirable � <br /> • Pn�perty Lines • Centerline of streel � �' <br /> • Outline and dimAnsions o�all exis�ing Tnd • Indicnte Norlh , <br /> propOsed sM1uclures on ihe lo' • Show nny proPo,etl i,7ra_mq char,qes � <br /> • FMisling and proposed ulilRies • Show measuremenis � � <br /> 00 NOT WRITE BELOW THIS LIN[ <br /> PERMIT CONDITIONS O I <br /> 1.All calls lor Inspec�ion shall be made 24 hrs.in advance�phone 259$910. � I <br /> 2.All v�ork shall be peiformed in ar,cordance with this permil onA currenl Gily ol Everelt Design and Conslruction <br /> Standards end Specllicatlons. <br /> 3.Cell Loca�ion Undergruund Servica 4B hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> 4 .AN1 CHl1�If;C IPJ THG DRIVEI-0AY CUT 1111�11 f�lr: !\f'PROVf[f, O <br /> C�1' THE PUi�L.iC WOF;f:B IN5F'L=CTOF<. <br /> f '„'i.UfiE f'lJfal_IC Df+/-11NAGE SYSTEM A5 f'f20VIDFD F=OV"t DOb1fJ'"�f't111I '3 . <br /> � <br /> 6./1NY LOT C'I:/-1DE CfIFlNCiE6 MUST E�F AFPFOVED UY ��HE � <br /> PUEq..tC WOF.k:S I�JSI'�CTOR. <br /> 7 f FFF CI'fY ;TFFFT3 CLEFltV AT 11LL. TIM[5. � <br /> � �3 INSTf�LI_ WM'FR GfIXGS Tfl .r,kF1DF" /-1T TIIF ENb Of CON'� Ilaw TTi)fl � <br /> E , 4 Ml11'E SUNE pk[VFI�!.'�Y6 ARE COMPLFTF:LY C'.URED F�EFOFif <br /> DF�IVThIi�. ON ri-irr�. � <br /> � .1i�. L1NY nnrinrE 10 7F{[� [,�,IF}:� 11Nf1 F1DF�W(11. 1�. WT11 1'�FI RF.f'lill��l�l� <br /> l f: "f l ll '3F1T T,il'(lf;T l l)N QF THF 1-'l llal_I C 4J11Rf�..`� I)Cf'T . <br /> ACKNOWL[OG[MENT OF CONDI7 pN5 <br /> _� �C.(� _ __ __ Tlie untle�signetl owner/�pphi•onl hereby agrees to hold and 5eve harm� <br /> -- less Ihe Cdy ol E�erelt Irom any and all claims lor tlameges. r,osts. <br /> espensF�. or causes ol nctinn that may anse becausr, o� installalion <br /> � -�` � � 7� 8 and m�nlenance ot Ihe imp�ovement or other ngiit-ol-way use hereto <br /> !l�7�y / <br /> ;�pphed Icr �nd lurther agrees to remove same upon nollce IrOm �he <br /> ApP�d,lor Co siru i Date City nnd lo renlnce U������ P«Perry damaged thereby <br /> ; � � ����/�� <br /> i � � �'L_ �/ �/��L� <br /> �j � //� � <br /> fIN L INSPF ON � Dele �z'!J—Ll.j�� <br /> Approved a5 ConSlrucleA Su natwe ol Apphcant Date <br /> r�+vrrrll PUBIIG WORKSDEPARTMENT WORK AU7HOR�ZFD BY THIS PERMIT MUST BE STAflTED WITHIN <br /> I� :?200Cetler51ree1 1JC DAVS OF DAiF PERMR IS ISSUED AND THEREAFTEH IS TO <br /> Evere��,WA98201 BE UILIGENiLV PUHSUED TO COMPLETION. THIS PEPMI: MAV BE <br /> Phono�.25[��8810 CANC[LLED BV THE CITY UPON ANV STOPPAGE OF WORK ON TNIS <br /> PROJECT OVER 90 DAVS DURATION. <br /> I, <br /> I <br />