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Dete �' -�i-� <br />qpplicatlon Foi <br />PUBLIC WORKS <br />Print or Type Only <br />Lhl-P�^ Ye <br />Ownei <br />Sr��t r�6c✓R <br />PERIVIIT <br />� , c <br />, , r� <br />'�'� i r, <br />n �,. <br />G619 Beu2l� 6'�✓V " ;:- �va2t.l,r <br />� ,. <br />Meiling <br />Atltlress <br />zC�ry <br />-. i.' <br />2 <br />�,, <br />Pup�¢ WaMe Permu � _ �/"��� / <br />nin9 oeoi • — <br />PuOhcWorF�fae s -- <br />louiFee <br />Lef��D01 feeVeuf S 2 v <br />Balance0ue S u5�' __ <br />�l/3'—sfs�s� — <br />z�p Phonc <br />Z,n Phone <br />Describe Proposed Work <br />GJ /✓/L•/ ,qr({'A� % ���" �� OL�S. � �vfrlLL! <br />rv nc� v;. �sa2_�F�•�G—�.—,XH � �R <br />p;ojecl Addrase lil knownl <br />6619 do��tu�t- ucv� ,-����,... _ <br />Pttech lour (4) copies of plans for proposed woik � Drew to scale end note the lollowmg as applicable, <br />• Property Lines <br />• Oulfine end dimensions of ell ezisting and <br />proposed structures on Ihe lot <br />� Exisling and proposed u�lllties <br />• Cen�e�line ol slreet <br />• Ind�cate Norlh <br />• Show any P�oposed gra�!�ng changes <br />• Show measuremeMs <br />PERMIT CONDITIONS <br />1. All colls lor Inspection ahall te metle 24 hrs. in ndvance - phc �e 259$g10, <br />2. All work shell be per!orrr.ed In accordance with this permil end cu�rent City ol Everatt Der'gn end Constructlon <br />Slendarde end Specilicatlons. <br />3. Cell Locatlon Underpround Servi� 48 hrs. before you dig. TOLL FREE NUMBER 1•800'424•5555. <br />i}, t=�M �-r � 5'Fc�2- P^„� �.x� o�v�.�{ i r.� arc.c�, t� 1 a r� l.. ie�,�h'�� <br />oN �-iv�►. P�.���� M�sr 6� ,=z�r.�� iN �����co��c.` <br />��/ �"Tl�t G� z`-�� �F i v �uL LT't S'i"T� � 1.�-"L.. . <br />1'�1L t-L�++�7 f�ATE"� ¢3-Zo�b <br />5. p- P?c� �.o-r��'r- 5 r+C-t�. M6'�T"� �u. r1✓rc2-a4-�'i- <br />y.��-i i 1�1 �t cr�GB "�.E'Qlv � fL�M�tf"'S FL9 � l�`A� �� Sr�T�I �.J6... <br />� <br />���� ,n/1C_' ^ O rt (� — 1 �R � J`r <br />� f � � <br />Approved lor Conslruc;ion � Dale <br />/ / �` /, cj <br />�— ' � /�G�-�C 1�' -/' / . <br />�_ � �,, <br />N/� INSPECTIO�� Date <br />Appro� ed as Gonst �ucted <br />�everet� PUBLIC WORKS DEPARTMENT <br />3200 Cedar SVee� <br />EvareU. WA 9B2J1 <br />Phone�.259�BB'0 <br />ACKNOWLEDGEM[NT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unde�si9neA owner/aPP�����nt hmeby ag�ees lo hold and 5ave harm� <br />less Ihe Ci�y ol Everet� trom any and all claims lor damages. costs. <br />expenses. or causes ol actinn tha� may ar15Q beceuse ol instsllation <br />and mamtenance o� Ihe imp�r,vemenl o� o�he� �i9h�-ol�way use nereto <br />apphed for and lur�he� agmes to remove same upon notice Irom Ihe <br />Cily and to replace puhlic I��operiy damayed Ihereby <br />�� p��y c� <br />o,�e <br />Signature ol Appl�cant <br />BOROnYSTOF DATE� PERM1 TSISESSUFD AND THEREAFT�FR IS 1'O <br />BE DILIGENTLV Pt1R5UFU 70 COMPLETION. iHIS PERIAIT MAY BE <br />CANCELLED BY 1H[ GTV UPCN ANV S"fOPPAGE OF WnRK ON THIS <br />PROJECT OVER 90 DAVS DURATION <br />