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1 <br /> ���a <br /> Hp� <br /> Q y . <br /> ��� <br /> ��� <br /> �y� <br /> �Q Oate�So ���.�.�,� �„-,�,�,.,�„��. 9o�45-5 ` <br /> 0 H APP�icalion Fm �a�nn n,.r� . 90/25651.__._-.._ <br /> n�g PUBLIC WORKS PERMIT ^���°°W���.�•�-- ------ <br /> .��.��.� s— <br /> � � ,� Z ��v eom re.v„m S- . <br /> �H Print or Type Only TO POSTI NG ''� __ a.�•���o�� s_'IA =_ <br /> gy <br /> H <br /> ��y <br /> � Lyle E Blank PO Box 2�66 Evrrett 98203 252-332G <br /> � Owne� Mndmy Atldress City Zip Phnm� <br /> y <br /> Owner <br /> --__. _--------� ---- � ------ <br /> Applicanl MailmcJ Adhr��ss G�v Zin Phonr�-- '-- <br /> Oescribe Proposed Work New Sina�4'.�BI6�lv ieS�dflIIC�-_ <br /> - - - W <br /> Prolecl Adtlress lil knawn� _�$ZZ�'...-CdS�ilO�d• _ � <br /> Atlach lour(4�r.opies o� plans lor proposeA work� Draw�o sr.al��nntl note Ihe Inllowing as apUhtable � <br /> • Property Lmes • Cenle�hne ol streel � � <br /> • Oulline and Aimenvons ol nll c.ishn9 anA • InAicate Norlh <br /> '�' pmposeA strucW res on ihe lol • Show nny proposetl qraAm9 chanqes <br /> • E�istin9 anA proposeA uli6hes • Show measuremenls � <br /> 1�I DO NO7 WRIIE 8[LCJJ THIS LINE <br /> '�' PERMIT CONDITIONS O <br /> 1.All cells lor inspec�ion shall be maAe 24 hrs.in advance�phone 259•8$1�. � <br /> ' ' 2.All work shell be pedo�med m accordance wilh Ihis permi�and curren�City ol Evereit Desi{�n and Construction <br /> � Slendards end Speciliwtions. <br /> '�1 3.Call Locolion UndergmunA Service 4B hrs.belore you dig.TOLL FF EE NUMBEfl 1•BOO•424•$S$S. � <br /> '_' a. �'.00F IJIZ-AIUS IO S� TIUNT LiN9� ZO 'Tl?t�.�GH i7(L/a11.1 O <br /> FI�I..El� �v�D2A�� 2oC.vC <br /> ' � <br /> � � <br /> ' a <br /> ►_� <br /> �_� <br /> � ACKNOWLCOGCMCNiOf CONDI71(�NS <br /> i � <br /> Thc undnrs9netl owner/iPP6cnnl herqlW agrens Io holA anA savc h,n nr <br /> �/�- — - 1e55 Ihe C�ty ot Everelt Irom any and all dauns lor tlama9es rotil�. <br /> 'J/���r erpenses. or cnuses ol nchon Ihal may anse because ol mstallnLon <br /> � ,^^ LL ^ t O_2_9� anA moinlenance ol Ihe improvemenl or olhcr n9hl�ol�way use� hrv��ln <br /> IV l Y ePPheA lor and IurO�e� n9rees lo remave samo upon notme hum Pm <br /> App�ov�A Constr�chon'' i Date City,ind to r• lar.e pubhc nroperty damageA thereby <br /> A /' �� � �y��/ �/ <br /> � ��� i%/ � � <br /> FI A�NSP�C O�fl fJ�� ���D:fle ��1.G.l��-��/-l�-�.�- --_ <br /> Appwved as ConsVuctetl ne ol Apphr,ant U:�N� <br /> iwrirn PUBLIC WORKSDEPARTMENT W0 K AIJTHORIZED �V THIS PEf7MIT MUST BE STARTED WITHIN <br /> 0 9200Cetlar51ree1 1 DAVS OF DATE PERMIT IS ISSU[0 AND PIEREAFTEH IS TO <br /> Evercll,WA 98201 �E �ILIGCNiI v PURSULO 10 COMPL[TION THIS P[RMIT MAv HC <br /> Phono�.259�BA10 ��NCGU[D �V 7H[CITV 11PON ANv S10PPAG[OF WORK�lN 7HIti <br /> P{70JCC7 OVE�7 90 GAVS DURAiION <br />