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��� <br /> "y y �'�7-�z-�s� <br /> M�, ,�,i DatE��-�7 r,��.i,�.w�.�..n�,�� <br /> y aieo o�m � — �iDO--- <br /> �C O Applicalion For <br /> ���111rrr PUBLIC WORKS P�RMIT °°°;o,:�.."' S - <br /> � i��,enPi ree re�e S— <br /> n .�b 0 <br /> 7o" Bai�nc�O�e S--=�-= <br /> � N Print ur Type Only <br /> ��g <br /> �Y � <br /> � H '�r�on 3�l��i- i/�,u/' -f � unn�.�rs� . � rU � _ /�13-� <br /> Y �-7� O nor y Mailing Adtlwss Gity Zip Phone <br /> C� <br /> H <br /> N <br /> g d w - SQ m e—_ Phone — <br /> Applicant MxilingAddresS Cit/ 2ip <br /> I/�_ �- f1 \ �/ <br /> �p� Duscribe pronnsed Work ��.YJ:— � LG n 7 �r� //�N/1)t �IYL/✓1�15 I.�__,�q�jl2L�(IQC� — <br /> , ���J -� C{'Inri Cii/l�i✓�s/� �.����5 <br /> _ �C]�_.,--a-.�—... <br /> — _ / <br /> - -- W <br /> Proloa Address D�kncwn) /7�Z � CA1iti/7 �{'Q � <br /> Attech lou•(4)coples �I plens for p�oposed work• Draw to scale and note the lollowing xa appliceble: � <br /> • Property Lines • Centedin�01 street � <br /> �� Oulhne and dimensions ol all existiny and • Indicate North <br /> proposetl sVucWres on the lol • Show nny proposed grading chenges <br /> • EaistlnB nnd proposetl utilities • Sho.v r.iensurements M <br /> W <br /> LU P'�'T WR17c dEIOW THIS UNE O <br /> �` � <br /> j �� PERMITCONDITIONS <br /> ` 1. All calls lor Inspec�ion rhall be mntle 24 hrs. in atl:ai�cr-phone ZB9•BBl 5. � <br /> � I I 2. All wo•k sholl be pedormed in acce�dnnra with�h�•�permit and cmrent Ciry ol Eve��lt Desi9n nntl ConstrucUon <br /> 1 � Standards end Specilications. <br /> , ��. 3. Cxll Locetlon Under�round Service 40 hrs.bebre you Ui�.TOLL FRCE NUMBEH 1•800•424•5555. � <br /> i 9 O <br /> � . /'J%�i��. iGF-��.�i ;S 7C� /�'Cf�./_� lf�:���2��,�a.VC1' <br /> , 6�,o.e.�,vr F�x� T,r��,�����,-,.._ ,: ;_s �r�• �„r �< �_ �',.,�r <br /> � `�, yEr T- BE r��n�,�1E�. �,. L' <br /> �♦ <br /> 1���� O <br /> a <br /> �- <br /> �._ <br /> � ACKNOWLEDGEMCNT OF COPIDITIONS <br /> The undeisigneA owner/apP���anl hereby ngrees to ho�d anA save harm� <br /> ��s� — — ----� loss �he City ol [vere'� Irom any and all r,lnims for dama�es. rnsls, <br /> ���------���///��- expenses, or causes ol ection Ihal may n�ise because ol inst�d:alion <br /> �—J�/ � /�� /' / nnA mamtenance ol Ihe improvement o� other ric�hbobway use hereto <br /> �,��� [T)a�%�°Z' �/�'/�� npplied br and huther ngir.rs lo iemove seme upon nolicn Irnm �he <br /> Ann�oved lor¢ nslrur, ' n � �A�e City anA to replace puhlic properly damaged Ihereb)•. <br /> , � % ,� <br /> G� <br /> _ �,�. , ; �1�_, r .� }�� ,_�-��� � ���.,__��—�i-� <br /> FlNAL INSPECTI N ��1e -1 —���� - Onte <br /> qpprovr.d as Conslructed Sign�lure ol ApP�ir.nnt <br /> PUBIIC WORKS DEPAR7MLNT P✓ORK AUTNORIZED BY THIS PERMIT MUST BF STARTEO W�THIN <br /> rvei��lt 100 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> 9200 Cednr Street BE DILIGEN7LY PURSUED TO COMPLETION. THIS PCRMIT MAV BE <br /> Everell,WA 98201 C�NCELL ED BY TH[CITV UPON ANV STOPPAGC OF WORH ON THIS <br /> 1 � r� Phone. :59�8815 f'ROJFC7 OV[�9�DAYS DURATION <br /> �.� <br />