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� /�_� '��6 r„n�.�wm.ar�.�m��. —I�O—��oJ <br /> .Date�s_r_ rlo <br /> ApPlir,e�ian For I+m�� o�.�� . ___ ___.._ <br /> PUBLIC WORKS PERMIT -- - -- - - - <br /> Pul��r Wnnslre <br /> Irlei�nn s__ <br /> .�uenn� �n.�rn�a 5 <br /> O� <br /> owiw��.o,,. S��=_ <br /> Print or Type Only -- <br /> � /� <br /> 'b, 11 � . ( ��L� � �1 �',1' <br /> Owner � ailing AAOress Gdy Zip Phonr <br /> ��.L.�1J�_-��Q_ — <br /> Apphcent Madmg Address C�Iv I�n Phone <br /> '-}�a,rk-t►JC� Lcr`� <br /> Uescrihe Proposed Work ---�------ <br /> Pro�act Addresa lil knownl —1��,1 � � FYaKKiNU u�T �E � <br /> � <br /> AltaCh�our(4)copies ol plans for proposr.d work � Drnw l0 5calp antl nole Ihe lollow�ny as applicahla � <br /> • Properly Lines • Centerline ul street � <br /> O Oulline and dlmensirns of all eRisting anA • Indir.ale IJorth <br /> proposetl 6tructure5 on the lot • Show any proposed ginding changes <br /> • E��stmg and proposed vlihties • Show measuremr.nls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PFRMIT CONOITIONS <br /> 1.All calls for Inspeclion shall be mede 24 hre.in edvance•phone 259•8810. � <br /> 2.!'.d wor�,fiall be pedormed in accordance with Ihis permit end currant City ol Evere'�Design end Coretruction <br /> Stenderda end Specitications. <br /> 3.(:sli l.ocellon Underground Service 4B hrs.before you dig TOLL F'HEE NUMBEN��800•424•5b55. � <br /> y �.�� Q� ��.� ��-���.,.�-��;,.� r��� O <br /> /2a�.�c,v�. ,e,,,,0 aa af%Yiatt,�6c� .-f.�ii Cct� �6l:rwa� c✓w'P� <br /> ,- ^/'�;, ,Qe�,�u./�.co .t.�c�e.� .�..�c�i�/ %Zc�yRn.�i �i �i�a� l�o�� "/� . � <br /> .,,f .�,�f,6 � �ty � ft,�,u.� .�� p->�.t��.Q�� � <br /> �ar.Pa"`c� Gy"e`�n+' ,d td2�zti �,ek�./.�-f< �C'crr���c� O <br /> ,afo�.r.�%tvu,��/ �_e��..�.r� a., /� <br /> „// �u;v �+,.�;ts. Sc� i'�✓ />'S�i9�'v i.✓ 9�'���,e.vrr li <br /> �� . �o� <br /> w�.,�s�vrv'0� e98- isi . <br /> �; � F�� F�L�� /'� ,I ���—�� ��� ACKNOWLEDGGMFNiOFCONDITIONS <br /> The undeisigned owncr/aUP��r,�nl hereby a9rees to hold and sxve herm� <br /> less Ihe City ol Everetl Iwm any and oll claims foi �amages. costs. <br /> e.penses. or causes ol aclion ihal mav anse because ol mstalletion <br /> � �"' ��?�� �nA main�enance o� ihe improvemeM or other nghl�o6weY u5e he�e�o <br /> apphCA lor an urlher agrees lo remove 58me upOn nohce irom �he <br /> �����Approv�d lo 'p�rucli/ � //' Date � y to re la e pu c p�operty damnged Ihere6y. <br /> ' l � - � ; � � ; <br /> ���E� �� ��Ak�0. 1 � ���1 � <br /> FIN�L IN�CTION � <br /> Approved as Conslructod Si nature ol AppLcant Oa�e <br /> pyp�p�� PUBLI:WOFKSDEPARTMENT WORK AUTHORIZE[1 OY THIS PERMIT MUST BE STAFTED WITHIN <br /> 1A0 DAVS OF DATE P[RMIT IS ISSUED AND THEPEAFTER IS TO <br /> � 3200CedarStrrel BE DiLIGENTLY PURSI:FD TO COMPLETION THIS PERMIT MAV BE <br /> Everalt WA 98201 CANCfLLF.���THE CITV UPON ANV STOPPAG[OF WORK ON THIS <br /> Phone�.25P�9B10 I PRpJf CT OVCf7 90 DAVS DURA�ION <br />