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, � <br /> ♦:YM� <br /> r..• <br /> �, k <br /> , <br /> � � � <br /> <,. .,„ <br /> � --- - -4_ -- - ---�----- - --- . � '� <br /> � <br /> O � t �_��J/!I . �'. ... - � ' . . .. . � � PUEI¢Wm��Paimn• ,. <br /> ��� �8�9 ' /� . : ��/ '� /] � � <br /> 8�0.1 Deo��• ' <br /> pppllcetion For I <br /> ��� � ` Pl1E,UC WORKS P�RMIT Pn0lcWarbfu ; <br /> Tcu�iaa � � <br /> �1 Le���oo�fee PaiO � I <br /> . ��e I B�I�nce Dw � I <br /> pa Pilnt orTyR�� Onl; I <br /> � v I t <br /> �� �ii�ilr� A �n � ei .vJ /Gi.? lc �.r � R. i�7 �/ � S�F- �� iFi j <br /> �p.�� Owner Mailin9 AAdress CIIY 2iP —' Phone I <br /> � �'� . �✓ — I <br /> �-1 Applicent Mailing Add•evs Cily Zip Phone <br /> W � <br /> �� Deecdbe Propoeed Work �7 /,� ��i T3 S !• iC • - -- I <br /> ' <br /> r <br /> - - W � <br /> Prolect Address III known) .1� �� Ls A r�•� � i <br /> i <br /> Attech lour(4)cop�ea o�Plans lor propoeed work-Draw t0 scele antl no�e ihe lollowing es applicable: � �� <br /> • Property Linen • Centerline ol streel � � <br /> •Outline and dimenaione ol all exieting and • Indicate Nor�h <br /> prcposed structurea on Ihe Io1 • Show eny P�oposetl grading changas <br /> • Exietinp end proposed utilitles • Show meusuiements M I <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> �- "� PEHMITCUNDITIONS � <br /> 1.All cells lor Inepection ehall be made 24 hre.in advance•phone 259•8810. � i <br /> ���� 2.All work shell be peAormed in ecr,ordance viith thls permil end current City ol Everell Desipn and Corsiruction <br /> � Standarde end SpecNicatlonn. i <br /> 3.CaIILocetlonUnderproundSenlce48hre.beloreyoudip.TOLLFREENUMBERI•800�424•5555. � <br /> � <br /> C�, �-1�Iv`r�e : i�i��,�a`t ur.,� �. ��c-� i��, i�i�rs ,;� O� ': <br /> �� _.i u� �._C. Wi k:r � <br /> Z� `,�- l LJC �l. �^� ll.� �1 Il�l_A C'L +-(�'c: f� �ti-�,.) � <br /> � O ', <br /> , �•- i o r't C�-r �,',i'r- . �. �c.0 � 1�t�LJ ->,�) ��. <br /> � ,� a ; <br /> __ ,., � <br /> _� -�—v�-�.:,�-_� � ��c�.� � �c�-�- �� c� , <br /> , I �� <br /> I�� �� -r- GG�rv_-Y v ��) G�.0 O LEDGEMENT OF CONDITIONS <br /> ✓` '�The undAfs�gneA�wner/uppGcanl hereby agrees�o hold and 3ave harm� . <br /> �� less �he CAy U t.voretl Irom any and all claims lor damages• costs. � <br /> � e�penses. or causes ol actlun Ihnt may arise hecause ol installation . <br /> and mainlonance ol ihn improvemenl or olher i��hl�obway use herelo <br /> applied lor .nd lurlher aprees tn remove sams upon notir.o Iwm the <br /> � Approved lor Construction ���e City nnd lo wplace pu66c prop�artY damaged th�ueUy. ' <br /> �� . � � � <br /> I — ._.. Data . ' ' i��. .. , ;� J_ �/ O <br /> FINAL INSPECTION �" ale <br /> I App�oved es Conslrucla� 5 gnature of App�ican� <br /> WORK AUTH()RIZED BY THiS PERMIT MUST BE START[D WIThIIN <br /> I� averett PUBUCWORKSDEPARfMENT IBO DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> i � 3200CeCarStree� BE DILIGENTL�i PURSUED TO COMPLETION. THIS PEHMIT MAV BE <br /> Evere�l,WA 9P201 CANCELLED BY TME CITV UPON ANY STOPPAGF OF WORK ON THIS <br /> Phcne�25?�9810 PROJECT OVER PO DA'IS Dl/RATION. <br />