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Date �—�3�95 <br />ppplicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mai��ng <br />S �r Y�^ 1� <br />Applicant M�dinp Address <br />Describe Proposed Work <br />s <br />u� �i h <br />j7�v,i�sf <br />we`c we�� w�mn . �_a1L.L�- <br />a� o.�. <br />wene we.�. r•. s <br />.�.� �.. <br />u.. •uw r« r.b s <br />B�I�rKa Ou� s �� <br />���6 ,3/d d'..7%2 <br />City ZiP Phone <br />e <br />Pro1ec1 Address (il knownl � ��' � "� � �r � <br />Altech Iou114) coples ol plAns loi proposod work � Draw lo stale antl nole ihe IOPowing as apUlicab�e- <br />� Prope�ty Llnes <br />• Outline and dlmensions ol all e�ishng and <br />proposed elructures on Ihe lol <br />• Exie�ing end proposed ulllilies <br />Sr sT <br />• Canterline ol streel <br />• Indicele Nmlh <br />• Show Bny ptopo9tld grHding chengr.s <br />• Show measurements <br />PERMIT CONDITIOI�S <br />1. All cells tor inspectlon ahell be mede 24 hro. In edvance • phone 289�881 O. <br />2. All work shell be peAormed in eccordence with thle permlt end currenl City ol Everelt Deelqn end Conetr�ctlon <br />Slendarda end Specillcetlona <br />3. Cell Locatlon Underqround Servlce 4B hra belore you dlµ TOLL FREE NUMBER 1•800�424•5555. <br />¢' CviL .f'rt6 /.ex+^�E � .�a o�or,e ��^ Q`Orove� <br />-, p�t�s �a��� ��/�s <br />FINAL INSPECTION Date <br />Approved es Conslructod <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cader Slreet <br />EvereO. WA ^0201 <br />Phone�. 259-PB10 <br />� <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersignetl owner DPI�Cenl hareby agreeb lo holC and aeve harm� <br />less Ihe Cily ol Ev tl li m eny antl all clalms lur tlamapes. costs <br />o■penses. or cau s o n that may erle9 because ol Inelellati�n <br />aod maintennn ol i provement or olher riphl�ol�way uee hnreto <br />app��eA lor a lur r greas to remove same upon notice Irom Ihe <br />Cdy anA to � PI ic properly damaqed Ihereby. <br />�-a.�-9s <br />yy K ZED BY iH13 PERMIT MUST BE STARTED WITHIN <br />� F DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />B' 1LI NiLV PURSUED TO COMPLETION. THIS PERAIIT MAY BE <br />CANCEL LED BY THE CITY UPON ANV STOPPAGE OF WORK ON THI� <br />PROJECT OVER v0 DAVS DURATION. <br />