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resin T <br />m- a4 -R(, <br />SITE ADDRESS S 131 P1 44 Av S NAME: OF PROJECT <br />NAME OF am Water District #125 (co -user City of Tukwila) P143NE <br />ADDRESS <br />CONTRACTOR <br />ADDRESS <br />FEES <br />QOM, Cur /ACCESS /SIDCVALK <br />Q CHANNEL I Z TION /S1WIPINGiS1G 4 I NS <br />IN R. .IC RIGHT•OP•WAY <br />PPlNK LOOPPWORAINT <br />LANDSCAPE iRR MOAT IcN! <br />PO Box 68147, Seattle, WA <br />Water District #125 <br />Sane as above <br />6200 SOUTHCKNTIR BLVD. <br />TUAWILA, wA 2E12a <br />PLAN CHECK FEE 10.00 (000/345.830) <br />INSPECTION FEE 15.00 <br />TOTAL <br />Waiver4 <br />RECEIVED BY N/A <br />RECEIPT /1 <br />PIRATION OATS 7 -21 -86 <br />sem moon 1 <br />g X Rif= MAIN Da s I ON <br />STORM DRAINAGE <br />WATER MAIN OCT ENS I ON <br />MiSC. Emergency Intertip <br />THE UNDERSIGN= WREST APPLIES FQ PERMISSION To install emergency intertie per approved plan <br />and Public Works letter dated January 9, 1986. Prior to sign- off /use of this emergency intert <br />a written approval to use this intertie shall be provided from the Water Superintendent for <br />the City of Seattle or his designee, per the requirements of the Seattle Water Department's <br />Purveyor's Agreements with Water District No. 125 and the City of Tukwila. Use of this <br />intertie shall be in accordance with the requirements of the City of Tukwila Public Works <br />iiinOPL.ICANT IWPS IFY 14, CT+DR Dave Grage (433 -1860 of CO MENCEMENT AN <br />CompLETiON OF WORK AT LEAST 24 HOURS IN ADVANCE. <br />PHONS <br />Emergency Intertie <br />242 -4750 <br />ZIP 98]. 8 <br />Z <br />Water District #125 ACCEPTS THIS PERMIT AND AGREES To ABIDE BY ALL <br />APPLICABLE SECTIONS OF THE CITY OF TU1KWILA MUNICIPAL CODE. EE AGREE THAT THE CITY OF TUKWILA <br />SHALL BE HELD HARMLESS FROM OR ANY CLAIMS ARISING AS A RESULT OF THIS PROJECT. <br />PERMITS WHICH HAVE LAPSED BEitR.>(A THE PERM17 EXPIRATION DATE SHALL REQUIRE A REAPPLICATION <br />RE 1 SSuANCE OF THE PERM l }R <br />\T TI-E C 1 TY i LA AT AN ADDITIONAL FEE (433-1849). <br />1T <br />APPLICANT'S SIGNATURE <br />PH Y RRM NOR RNOINCE!. 4,41-y 0IF TUKWiLA <br />TITLE .6712.t. <LT LA) d/ <br />CC: <br />APPLICANT <br />INSPECTOR <br />CITY SI•OPS <br />BUILDING OFFICIAL <br />FINANCE DEPT. (IF APPLICABLE) <br />FIRE DEPT. (IF APPLICABLE) <br />1 HEREBY CERTIFY THAT THE PERMIT HOLDER WHOSE NAME AND ADDRESS APPEARS ON <br />FACT 1 LY MET THE STANDARDS AND CONDITIONS FOR THE PROJECT APPROVED I.ERE Aoh <br />I /j <br />FIELD 1 NSPECT I ON DATE 7— 66 <br />PERMIT NOT SIGNED -OFF BECAUSE <br />CITY INSPECTOR <br />INITIALS DATE <br />AND <br />iS RECORD HAS SAT! <br />