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i <br /> � <br /> � <br /> . � <br /> . <br /> Date�-��� �,.,����� w.,,..,�����.,�� . ,� ph - !�7_. - i <br /> Applicalion For Bmp peo� • �.-.(J_yi� <br /> �___- <br /> PUBLIC WORKS PER�VIIT �°^;�„�,:'�° : _. <br /> lese�oni ��e Pn�e S <br /> Print or Type Only e,�a���o�. s��� <br /> �nrnan✓� iar�s}- 17371 N�:��� C� ��.21� 12�� �f�0'Sol �'c�s- $�l`)C� _ <br /> � MaiPny A dress Ciry Zip Phone <br /> Apphcanl Maihny AdtlrosS City Lp Phonn <br /> DescribeProposedWork �_�� c�nG��'#9c(1�.�—/�y�(.�p((fR_ L6 ]� ��L�t�.nN /�/Rf.Q <br /> J' <br /> Pro�eclAddressplknownl 9ob - //Ot� ��, s.� __ � <br /> � <br /> Attach four 14!copies ol plans lor proposed work� Draw In scTle and notr. thr lollowing a5 appl�cahlr� � <br /> • Property Lmes • Cen�erline of strr.•t ♦A � <br /> • Oulline and dimensir.ns ol all e*�stinq nnh • Ind�cate Noith V� � <br /> proposed SVuctures on Ihe lol • Sr,ow xny prnposed 9ratlm9 chan{�es <br /> • Ezisling nnd proposed uhh�ies • Show measin��ments � <br /> UO NOT WFITE BELOW THIS LINE <br /> PERMITCONDI710NS O � <br /> 1.All calls lor Inspection shall be made 24 hrs.in edvence-phone 259•8810 � <br /> 2.All work shell ba pe�formeA In accordance wlih this permit ond current City ol Ever�•tl Desiyn and ConsVucl�on � <br /> Stenderds and Spei�'fieolions � <br /> 3.Cell Locetion Undergioimd Seivice 40 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � . i � �� � . �_ -, ., . . , . � ��. <br /> S.� U��E r U'r.;� i;_ ��Fr=�.I��i+Lic. ,`� i:i l i:l'I i�i�:i F'kU��� <br /> raniv �.nT �ra�t: c,�iAnirE�� iausr �F r�r>r-; <br /> UEtLTC WpRt Ei Ihlu1=•�:ClpFi. � <br /> I-Li-• CT i'Y f;l�f:E�'� �� � � � ✓� , , , i � , � <br /> � IVSTA�L 4+ATEF � <br /> �� r "!., ��� I � <br /> � <br /> ACKNUWLEDG[MENT OF CONDITIONS <br /> The undersiyned o.vner/apphcnnl he�eUy agrees to hold end sav:•h ����i <br /> less the Cdy ol [veretl Irom any and all claims �or Aama9es � .��� <br /> eapenses, or causec ol action Ihat may arise berause o� ins!ali,,i. - <br /> (� C•' /�� � , ���� and mainlenance ol the improvement o� olhe� righPol�way use h�.����� <br /> Z.F1G3:roI� npplieA lor �nd luriher a rees to rnmove same upnn nohce iro�= � <br /> pp ov �lOr COnS�r C ron � , 4 �e City�rt lo rea�ar.e puh c p po�ty damayeA thernUy <br /> A r /P�.� �C...�J �/�/. GL / / {/Y.; _ �� � � =>�f. �� <br /> FlNAL INSPECTION �- Dale . ^ �-" L '� <br /> ApprnvoA as COnS�rut�ed iQ atw 61 pp I ���e <br /> WOH UTf OR�L[D 81' iHl cNtil1T MUST �[ STARTFD WITHIN <br /> ��vwell PUBLICWORKSDEPAR'fMENi 180 AVS � F DATE P[RM ; ISSUED AND THFR[AFTER IS TO <br /> � 3200CederSireel BE D �NTLV PURSUEL COMPLETION. THIS PERMIT MAV BE <br /> EvereO.WA 98201 CANCELLED BV THF CITV UPON ANY STOPPAGE OF WOf1K ON THIS <br /> Pho�e.259-BB10 pRp,IFCi OV[R 90 DAYS DURATION <br /> � <br />