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Dete_.$�1L{8G a��i,i��wo,.s v.,m�n.f n. <br /> Appllcetion For u�ea oso� • �p�v�—�6.2�a.-� <br /> PUBLIC WORKS PERMIT °°°°°W°,'.`°° . — <br /> TMeI iee <br /> Leu�oO� FaePuO � <br /> B�ianca Ou� 6 <br /> PNnt or Type Only <br /> �a�Mn/ 7.a L �lal l -,�p��J�Y.�I SH„4 ZCZ Gv�w�,� 9dr/36 77�!-GY'/y`�' <br /> Owner MaIIIngAddress City � Zip Phone <br /> c d/�-.�—ya�o -/��c� s� r��� �.,�Hwao� /r Gt36 �'7/�3P0 <br /> Apphca t Mallmg Address ^�Y ZIP Phone <br /> Descrlbe Propased Work /'UNn„�" lMil lMvd Qi,(�r11Y f �AT1S—�l�f Y � — <br /> J <br /> W <br /> Proler,t Addreas(11 known) �_k:�61j_J3-.Q�—+�H��� � <br /> Attech lou�(4)copiea of plena lor proposed work- Drpw to scele and nota thn lollowing as applicable: � <br /> • Proparty Lines • Ganterline ol stren� � <br /> � Oulline and dimenslons OI ell existing end • Indlcate No�ih <br /> propoeed struclures on the lot • Show any proposed gretlinB chenyes <br /> • EMlstinp and proposed utilities • Show measuremen�s � <br /> 00 NOT WRITE BELJW THIS LINE O <br /> � PERMITCONDITIONS <br /> 1. All calls lor inspection ahell be made 24 hrs. in advence- nhone 259•881 5. � <br /> 2. All wak shell be parformed In accordence wilh this permit antl currant City ol Everelt Design antl Conslruclion <br /> Stenderila end Specifications. <br /> 3. Call Location Underpround Service 4B hrs. bafore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �GJ �E�sn�% �T .�E4/�i.eE'� s�y O <br /> c��v ~ <br /> � <br /> � <br /> a <br /> P,C�:NU67LEOGEM[NT UF CONDITIONS <br /> 7he undersigned owner/aVPlicanl hereby agrees to hold and save harm� <br /> less ihe Ciry ol [veretl I�om any and all cleims lor damages. costs, <br /> eepenses, or causes ol aclion that may e�ise becausu ol installalion <br /> and malnlenance ol Ihe �mDrovemen� or other riqhbo6way use herelo <br /> applieA lor xnd lurther agrees to remove seme upun noLce hom the <br /> Approved lor Construclion �a�e l:ity and lo replace public pr�perty damageA Ihereby. <br /> FII�AL INSP[CTION �ate <br /> Approved a�Conslructed Signature oi Applicant Da1e <br /> �rverett PU9LIC WORKS DEPARTMENT WORh: AUTHORIZED BY THIS PERMIi MUST BE STARTED WITNIN <br /> � 3200 Cedor Street 100 D.1Y5 OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everell,WA 9D'201 BE DILIGENTLY PURSUED t0 COMPLETION, THIS PERMIT MAY BE <br /> Phone: 259�681 S CANCELLED BV TH[CITY UPON ANV STOFPAGE OF WORN ON THIS <br /> PROJfiCT OVER 90 DAYS DURATION. <br />