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_ � '� � <br /> , ,. i <br /> s ; <br /> � <br /> ��q oa�e� PUI�L[WarA�Pn "7�''1��'9/n��29n__✓ <br /> �� APolicalion For A�no oeo� • �OLlGIUA3>—_- , <br /> � PUBLIC WORKS PERMIT Puoton�Fna'�� s_ ---------:_ <br /> ��� �� Leu�nn� fe<P�WS — . <br /> � � Print or Type Only <br /> TO POSSIN� �� O�lencn Dun {�Q�O <br /> p �� r�✓� �I.'1 ►r��� 1�� �',t19'�f' ���Lkl �3-�1,�15 <br /> � Owner Mading Atldress C�ty 2ip Phone <br /> M � Jt1/i'i <br /> . � qpplicanl Mallmg Atldress CAy Zip Phone - <br /> �� C_r <br /> Descnbe Proposed Work [ .7�� <br /> �� <br /> .. .r.�r�.. � . <br /> Project Address lil knownl /��-J ! r/it.�l-L� LN. � � <br /> � <br /> , Aftech faur�41 copies ol plens lor proposed work�Drew lo scalo and nole Ihe lollowing as apP���able�. � <br /> • ProOerty Lines • Centedine ol street � <br /> •Outline antl dimensions ol all exisling and • Indicale North <br /> . , proposed structwes on Ihe lot • Show any proposetl graAing changes <br /> . • [Mislmg and proposed ulilities • Show measurements � <br /> r��� �. DO NOT WRITE BELOW THIS UNE O <br /> � i <br /> � I PERMITCONDITIONS <br /> � 1,Ail Calla for InspeGtlon Bhell be metle 24�r9.in BtivanCe•phone 259•881 Q � <br /> 2.All woik shall be pe Ao�med in accordence wllh Ihis permit and current Clly ol Everatt�esign antl Conslructlon <br /> ; •_� StanAarde and Specllication�. <br /> i `�� 3.Call Locetion Underpround Service 48 hrs.before you dig.TOLL FNEE NUMBEP 1•800�4245555. � <br /> i O,I ,_� <br /> � ��� <br /> �� �� � � <br /> , �_� O <br /> � a <br /> __ <br /> I '�1� � ACKNOWLEDGEMENTOFCON�ITIONS <br /> � ��� Thu undersigned owner/applicenl hereby agrees to hold and save harm� <br /> less Ihe Cily ol Everetl Irom any and all claims lor damages. costs. <br /> � / eKpenses, or causes ol a[tion �hal mny arise because ol installalion <br /> � %/�'A!/%== �17' -���y�y� �nd mamtenance ol Ihe Improvemen� or other ngh�-ol�way use herelo <br /> applied lo� and lurlhei agrees to remove same upon notice hom Ihe <br /> Approved lor Conslruc � Dale GI f to replace pu6hc property damaged thereby. <br /> .��, � 7(r' �p � <br /> FINALINSPECTION Date '� �V��✓ /�� "-��� <br /> Approvnd as Conslruc�ed Sign m pphcanl Uate <br /> everrft PUBLICWORKSDEPARTMENT WORK AUTHORIZED BV THIS PERMIT UST BE STARTED WITNIN <br /> � 3200CedarSireet IBO DAYS OF DATE PERMIT IS ISSUEO AND iHEFEAFTER IS i0 <br /> Everel6 WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON 7HIS <br /> PROJECT OVER 90 DAVS DURATION <br /> � . <br />