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f'�:1_z <br /> � C" 'i1 <br /> t+7 <br /> A � x <br /> C H <br /> 9yCn <br /> � <br /> y � � <br /> O x O Dale G/25l90 v�m��wo,w9vP��,... ----� ' <br /> 'ti M �{'i n�;�, unn .�0/242b0 . <br /> y H ApPlica�ion For <br /> � �� PUBLIC WORKS PERMIT '-•'°„°"° s _ <br /> :,��.,��� <br /> �,,,.�,�� «,�,,.,, s <br /> e.,�.,�-..,n.:.. > <br /> ��g Print or 1/pe On�y - <br /> zH� <br /> x <br /> H H Gencral Hospital h]edical Centcr 1321 Colby �vcrett 9£4�01 258-6517 <br /> g y Owner Maihn9 Addruss GIY 7�p Fhone <br /> H <br /> C�l7 C/� <br /> ��� trwner - -- -- <br /> �, H] q� Applicant Mailm9 Address Gty Zip Phone <br /> HOtn <br /> Describc Pioposed Worh T I (Va�Lar Suraervl — <br /> W <br /> Prolect Address lif knownl > »n no���.}�Ea�($�yp_-gl-) — � <br /> Attach lour 14)copies ol plaos lor proposed work� Draw to scale and note the following as applicable� � <br /> • Property Lines • Centerline of slree� ♦^ <br /> • Outline and dimensions ol all eaisting and • Indiwle North V� <br /> proposed structures on the lot • Show any proposeA p�acl�nc chunges <br /> • Ezisling and proposed utilities • SI'�o'.v measurmnents M <br /> W <br /> I �� DO NOT WRItE BELOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> 1 � 1.All calls for inspeclion shall be ir�de 24 hrs.in advance�phone 259•8810. � <br /> �r� 2.All work shall be pedormed in ac.:ordance wilh ihis permit antl curte.nt City of Ecerett Design and Construction <br /> � � Standards and Specilications. <br /> , � 3.Call Location Unde�ground Service 48 hrs.belore you di9.TOLL FREE NUMBER 1•SOO•424-5555. � <br /> �� �! O <br /> I � <br /> � ��� / � � � <br /> i�� . � � . . , . . . . . . . �� � <br /> � �_� , . � <br /> O <br /> __, a <br /> ����� � � FlCkNOWLEDGCh1[NT OP GONDI110NS <br /> lhc undeus���noi�owner/apPlic.ni tmrebY�9�ees�o hold andsave hainr <br /> Ics;�, 1he Cny N Eve�elt Irom any and .II claims lor damapes, ccsis. <br /> expenses, or causes ol aclion ihat may arise becausn ol inslallahon <br /> ancl maintenance ot Ihe improvement or other ngM-ol-way usc herelo <br /> applieA �or antl furthcr agree5 to remove samc upon noticc irom the � <br /> Approved lor Const�uG�ion Dale City and lo replace putilic property dama!]ed�hereby. <br /> FINAI WSPECTION Datc -- — �,��� <br /> qpproveA.is Consirucled s��nawre oi nnni�c: �' <br /> WOHK AUiHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> i,��i.��.�� PUBLIGWORKSDEPARTMENT 1F10 DAYS OF UAT[ PERMIi I� ISSUED AND THEREAFTER IS T�� <br /> � 32COCedarStreel pE DILIGENTLY PIIRSUED TO COMPLE'TION T4-IIS PEFi61t7 '1AY E3L <br /> Evereti.WA 98201 CANCELLED QY THE GiY UPON �1N1'tiTOPPAGE OF V:'OR�c c'N t11iS <br /> Phone�25D��B70 PROJLCT nV[R 90 DAVS DUR����ION. <br />