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Date_Is�_-�� , � _��,�. <br /> r�,�ni�� w,,..,i,.m��. <br /> AnPhcnlion For ���m� Drn� . _.__ _ <br /> PUBLIC WORKS PERMIT ------ -- - <br /> Pueer War�efre <br /> tnlnl{!p S! . <br /> 1�45A(1�I (111�V��i�li .. <br /> Print or Type Only A.��� �n„� _s 2Z— 6s� <br /> . <br /> ��I��C� �/'x'1� 1,( )� � `'kl�l,/� 7 � /�i/cl�- <br /> Owner Mailmg Adtlress Cny °L Pnonr <br /> n <br /> c• <br /> . �41���3_ r2� _�1�-��-- <br /> APPhcan� MadmgAtltlress C�IY —�Im--- �--- phonr -- <br /> Describe ProPosed Work _�CJ.�„Y� � iJ�________.___.____________ ______ <br /> -- ___�,�.�- �o � z W <br /> Pro�ect AdAresa(�I knownl _ ��1(J� .� 7 ( /ycrS� �� _ 7C7'"Q.s .CQ� � <br /> �� �Cl <br /> Attech lour�4)copies ol pIBnS lor proposr,d work� Draw�n scale antl role Ihn lol!owing as apPlit�ble � <br /> • Propetty Lmes • Cenlerline al stree� � <br /> • Oulhne and dimensinns ol all e.isting anA • Indlcale North <br /> proposed Slructure5 on Ihe lo� • S�ow any propo5ed g�admg c�pnges <br /> • E•isling and proposed u;ililies • Show measuremenis � <br /> DO NOT WPITE BELOW TNIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All ce1181or inapectlon ahalt be mfltle 24 hrs.in advence-phone 2S9•8810. � <br /> 2.All work ehall be pedormed in accurdance with�his permil and cur�ent Cily ol Everetl Dnsign end Conalruction <br /> Standarda entl Speclllcetions. <br /> 3.Cell Lucetiori Underground:iervica 48 hrs.before you dig.TOLL FREE NUMBER 1•800•OQQ.5555. � <br /> /, / �O✓��J 2i+t� G�I�C-/3�t�� _ ��✓��� J.i''ACC,��1 �rsJ �v/f� O <br /> ��jY/�/.I� .Q�+� .'ta• C/�+�c�/LO�' �.XXf�C�c(.y �.G��i6'CUJL6o (TlfJ� <br /> T� v o <br /> J` .y.�ca� �i��/ .to �e�oo�e��c�iG .i2v�a�.�- �Co -dtd d'ou;,� � <br /> ('vs„�+,.� 4��eerru-n:7� ,cv�6G.� C�,t�y c� �rx�xtj` .� P�ve.�� � <br /> ,o�iu�t-wa-t�u t�x`vr' �••� cua.z`�i �,� l'c�rr��n/ °� O <br /> /Zci,ne� �ncM �ilev� �.ai S�, .G„ ,939 �.v r, 9cm:�a4.�.r a <br /> Gfiir.✓ S�irr '0`6g-/�`9 fi s,eµo �'88-�5<a� <br /> ��� � �'C �� /�'�/-�� ACKNOWLEDGEMENTOFCOND1110NS <br /> The undersgned owner/apphcenl hcreby q{�rees to hold and snve harm� <br /> less the Cny ol Everel� Irom nny and all claims lor Aamnges, cosls. <br /> � e.penses. cr cause3 0� nr.Uon �hat may an5e bec�use ol mstalle�ion <br /> q� ,. � /� � �. � and ma�ntenance ol ihe improvemr.n� or other nghl�obway use here�o <br /> apphed lor nd Iwther aqrees tc remove same upon nolice Irom the <br /> APProv➢ or�on uc)� n. � ' Date <br /> � �.- � � � GI 1 re la puhhc pwperry damagetl ihereby. <br /> i ��� /' � �-� �'/7 <br /> i ^ <br /> FIN L IN I - o� �" pg�� � µ� . I l l�� d I lE�Cv I Z� Z <br /> Approved es Cons�ructed Signalure ol ApV6c nt J�J _F p t�. <br /> everelt PUBLICWORKSDEPARTMENT WORH AUTHOR12ED BV THIS PERMIT MUSi BE STARTED WITHIN <br /> � 3200CedarSireet 1B0 DAYS OF DATE PERMIT IS ISSUED A��D THEREAFTER IS TO <br /> Everftt,WA9B20� �E DILIG[NTLV PURSUED TO COMPLETION TNIS PERPdIT MAV BE <br /> Phone.259�8810 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT JVER 90 DAVS DURATION <br />