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��� <br /> A� GyC / <br /> �y u 9p -.353 <br /> ruoLc worY.Pe. � <br /> ��� Date�LC�90 TO POSTING az� q e1apDeo� .�t�_��� <br /> qpplicaticn Por <br /> ��� PUBLIC WORKS PERMIT Puei�cwo�xerea <br /> iMei Fee 5 <br /> y � less Ano� �ce re�a S <br /> '3 y, �G5�-=s <br /> Bainnce Oue S— <br /> � H C Print or Type Oniy <br /> OH <br /> � g <br /> ��, � 1�/11 � /��/1f1��_" � nl�-�- I �i1lilr� ��� ��z�'�r.�� 4���r ��-.����' <br /> � y� �w�er Mailmg Address City Z�p Phone <br /> g y y -r��� �������,������v_% rn�r�.� ������r���gcr�.� Q��: <br /> O CJ�~/J Applicant Mailing Address Cily � Z p Phone <br /> �� W Descnbe Proposed Work ����� <br /> HOtn <br /> W <br /> .- � �� c �'"' <br /> Pwjecl Address lil known) ��� <br /> Attach lour(4) copies ol plans for proposed work- Draw lo scaie antl note Ih ollowing as appGcable � <br /> • Frope�ty Lines • Centerline of sireet � <br /> • Outline antl dimensions ol all ezislin9 and • Indicaie Norih <br /> prOposed SlNctures on Ihe lot • Show any proposed 9radmy Changes <br /> • Existing and proPosed utilities • Show measurements M <br /> W <br /> DO NOi WRITE BELOW THIS LINE O <br /> j PERMIT CONDITION� <br /> 1.All calls tor inspe�.tion shall be made 24 hrs.in advance-phone 259•8810. � <br /> C�� 2.All work shall7,p=Aormed in accordance with Ihis permit and curtent City o1 Eveieit Design and Construr,tion <br /> 1 , Slandartlsanc Specifications. <br /> 3.Call Location U�derground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> ��� �. / <br /> . . � ,�f (.c;. �C��o� llJ� �O Oi (�O�W�.Q�:/��2.�:.1 ���1dL<<� � <br /> 6y f.� ��/�� �l�Y d�f�f. ���:��/ � �-as_�� . <br /> � �.� � -,� f7 �� � �i' � ,�o :e�c �/,�,�. f�,•:, n lf;c��� � <br /> � rJ'GCii J_!Ld �^ Qtf�/'( � � <br /> � i �� O <br /> � Q��9�r'.�c� ' �2 2 <br /> �� O <br /> __ a <br /> , ,__ <br /> v� . <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> I � The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> I �t=� less Ihe Cily of Everetl Irom any and all claims for damages. cosls. <br /> � j expenses, or causes o1 adlon Ihat msy arise Uecause cf insLtllation <br /> �\ � /��`. !y � �5 n and maiNenance ot the improvement or olher righFof�wav use tiereto <br /> fl . f�- applied lor and further ac�rees to remove same upon noLce iror the <br /> Approved lor Co siructio Date City and to rep�ace puhlic properh damaged�hereby. <br /> i� <br /> ��� I S �/� 7� � �� <br /> �-- � ,.� /�- '�- <br /> FINAL INSPECTION Da e �� � � �� '" �r " <br /> ApproveA as Consirucled Signature ol A plic nt Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEU WITHIN <br /> evrmtt PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DI.IGENTLV Pl1R5UED TO COMPLETION.THIS PERMIT MAV BE <br /> Evernit.WA98201 CANCELLED BY iHE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PF70JECT OVER 90 DAYS DURATION. <br />