|
i
<br /> �
<br /> �, �,... .
<br /> Date; , . ; ._�
<br /> '_.. ` o�n„�M•o,..��,m��.
<br /> Pino Den� . __i'. ,
<br /> qppliCa'iun for i
<br /> P�1Bl�_IC WORKS FEP�MIT ��°°�w°,�°��� --- �
<br /> ,�����.� s —
<br /> ,
<br /> �.�••.�nN re«vnm S i
<br /> n.,i.,��aa�. S ,.���<S—
<br /> Print oi Type Only �
<br /> � I
<br /> . �r������.� �_� � � : � � � i� 1 i, , � ' !/ C I� � l�_ �� �� l- '�1' � 1 i�� ��� _ �
<br /> Owner Mxiling Address City Zlp Phone I
<br /> ., y �,C_ �
<br /> Applicant Mrdling Addross City Zip Phone I
<br /> ) �r 7 i
<br /> DescribePioPosedWork _ � C � �.. ) f`�<_.. � �,� � . �� / �����.' YJ � t �����'.� 1�/ �
<br /> - - - W ;
<br /> � Prolect Address lil known) /�� �- � � //�.�.'�� — .- � � ',
<br /> I�
<br /> Altech i0ur(4) copie5 0l Olans lor P�oposed work� Draw lo scale nnd nole the �ollnwing as apphcable �
<br /> • Properly Linvs • Centerhne M s�reel � �.
<br /> • OuUine and dimonsions ol all exlstmg antl • Indicate Nor�h !
<br /> proposeA slruclures on ihe lot • Show nny propOSeA 9radin9 rhanyrts ��
<br /> • Exisli^g and propooed utillties • ShOw measurements � �
<br /> , �- DO NOT WHITE BELOW THIS LINE O �
<br /> i
<br /> " PERMIT CONDITIONS ��
<br /> � 1.All calla lor inspeclion shxll be mede 24 hrs.in advunce�phone 2S9•8$�0. � ',
<br /> � 2.All work shali he pedormed in accardonce with this poimit and current Ciry al Everr.11 Drsign and Conslruction
<br /> Standerds end Sgecilirations.
<br /> � 3.Cell Locallon UnAer�ro�md Service AB hrs.belore you di9.TOLL FREE NUMBER 1•800•424•5555. �
<br /> i
<br /> O
<br /> � _,. t�'�( I L�i, � i �.,I � : ', ., .. � '. , � �, � i �, . �� , : �. . . � �
<br /> ' . . i1!:11 .I)1� I�hAi)I 1.:h1i1NrE;3 MI IS f f9E (al � ,� � .. � � . � p I
<br /> , � .� � . 1 I��ill•) , � ' �� . �/
<br /> _ . �� I � � � �, i �� � i '_: � I I �d�d r I � �� ' I i P n �
<br /> iL•+, 7�(SrAcc u/Are� 6oxEs To �.eNu.� 9r�i/F �'.�io a� 4��'r�•,, ;��'
<br /> i `� n)P,E� Si.SE'� Of'i(.�Fi.:,t'�{ flt.'F r'Ui,x��'F%72�/ �:'.Uc'F_/J B�F;•.� a
<br /> � D.2i�+-.v,: a2� r,�r-,. ,,
<br /> �
<br /> jACKNOWLEDGEMENT OF CONDITIONS
<br /> � lhe undersiyned o�Hn�i/apPi�cant hereby a9�ees lo hold anA sare harm�
<br /> ' less Ihe City o� Everrlt bom any and all claims lo� Aamages. cosls.
<br /> I / / ezpenses. or causes oi �r!ion ihn� f112y BfISP bCCAUSC ol inslallalion
<br /> � ` � �-. and mninlenance of ihe improvemenl or other nyhl-ol-way use herelo
<br /> l. ��� �7Bb//�"' -7 /Jr%��, �
<br /> .� xpPhed lor and lurlher ayrees to rr.move seme upor nolice irom Ihe
<br /> .I Approved lo� onslruction Dale� City anA to�eplace pu6lic p�operty demnged Ihereby.
<br />�. � — _ � ., /,//, , i �,,
<br /> � FINAL INSPFCIIUN Date - � � - �� � - ��"' ` '�,�-1=�� �I
<br /> Appreved ns Conslnir,ted Si9naliue ol Applican� � � Dete
<br /> rv�rrtt PUBLICWORKSOEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHW �
<br /> � 3200CedarSlreet 180 DAVS OF DA'�E PERMIT IS ISSUED AND HEREAFTER IS TO �
<br /> Everell.WA90201 BE DILIGENTLY PURSU[D TO COMPLGTION. THIS Pf.RM1T MAV BE
<br /> Phone�.259�8910 I CANCELLEO 9Y THE CITV UPON ANV STOPFAGE OF WOqK ON iHIS
<br /> PROJECT OVEN 90 DA'/S DURATION.
<br /> I
<br /> I
<br />
|