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Date�/(p��`(� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owne� <br />Mallm9 AtlAress <br />Describe Proposed Work <br />Arolecl Address pl known) /7�� ��/ y <br />C�ty Z�p <br />F <br />r�n�i��. w„��. n�,m�� . J (v � �%�% / <br />nina n�ni � �� /{��-1� <br />� <br />Punbc Wnrxe �ee <br />Talni lee S — <br />lnfsAppl foo Ve�d s_ ^n t—�_ <br />Aeience Oue S �l <br />Altech lour (4) copies of plens lor proposed work - Draw to scale nnd note Ihe lollowing as apphwble. <br />• Property Linos • Centerline ol street <br />• Outline and dimensions ol ell e�isting and • Indicate Norih <br />proposetl structwes on the lot • Show any proPosed c�raAmc� r.hanyes <br />•[xisling and p�oposed u�ilities • Shoa meusuremen�s <br />WRITE �ELOW THIS LI <br />I'hone <br />PERMIT CONDITIONS <br />1. All calls lor in5pec�ion shnll be made 24 hrs. in advance � phon� 259•8A15 <br />2, All work shall be pe�lormed m accorAance wdh ih�s pnrmit and cwrent Ci1y ol [veiett Dr:,�yn and Construction <br />Standards and Specilicallons. <br />3. Coll Location Underground Service 48 hrs. belore you di9. TOLL FREE NUMBER 1•800•424•5555. <br />� �.li..ST�%LC /.-1 �;/%, (f-'�_'t- -�e 'r:- �!i �� �'��'C'c'G��� <br />,��:, E�,,,�y <br />+� /�.�1�c,G�i� T 7= ��< <-cJ �/ � ' �� f'' .c'�., ,, / >, � <br />///c� �'i%� l'�� r � � , � J% /'C �L, � ,S �.. / ��,� 'lI/'% <br />'�i��=- �/���� <br />Approved I Consiruclion � <br />r <br />S ?.�, i5� <br />FWAL WSPECTION � Da�a <br />�nn�oveA as ConslrucleA <br />rve•mtt PUBLIC WORKS DEPARTMFNT <br />� 3200 Cedar S�reet <br />fvnrF�L WA 9A201 <br />1'hnno 259-t3f7t5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />O <br />F- <br />Y/ <br />O <br />a <br />inc undeis�yneU owneN�pphcnnt here.by agrees to hold antl snve harm� <br />less the City ol Evt�ietl Irom any and TII claims lor damages. costs, <br />ezpenses, or cnuses ol acUon Ihat may arlse brcause of Installatlon <br />and maintenance ol ihe improvement or other nght-ol�wny use herelo <br />applied lor and lurther agrees lo remove same upon notice Irom Ihe <br />City . nd to rep�ace publlc property tlamageA Ihereby <br />--- --- <br />, i; _i�,_ � � <br />Si�"natur�nl Date <br />WOHK l�UTHO�IZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AN[7 iHEREAf7ER IS TO <br />�E DILIGENiIV PURSUED TO COMPLETION. THIS P[PMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WOfiK ON THIS <br />� PROJECT OVER 90 DAYS DURATION. <br />