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�8�8JG�f.e�l/� f'u�iiic W�rhe Fnrmii� ! L7� -35� <br /> emo o�M • _ . __ <br /> qpplicetion For <br /> PUBLIC WORKS PERMIT °�"�;o�;F�`°° s -- — — <br /> �en eoo� �en vu,. S�r <br /> Baience Oue 4 7 �O <br /> Print or Type Only <br /> h1S of!-zE <br /> �D_Fi.f/G ConiA�7E.f'u9L �9,••vP�,�t�EJ f.�daX,1'Ja7 �9l1G�ldr��8/Zf�-220 7 �f�Z-Gi97/ <br /> Owner Ma11in�Address C'ty � Z�� �j,19X PANm���K <br /> f9r�o". -- — -— <br /> Applieenl Mailing Address �-�ty Zip Phone <br /> Describa Proposed Work ��S���T�'�'� �—�L� ��ti9aT� C[,E�p�����- A.t/Q_____ <br /> /POU[�if /l�c'AO/N!r f� �iD.e.tivG Cn�J d,� i•vero in.' J��oiY �s-9- B/ <br /> - W <br /> Prolecl Address lil known) Ev¢�� ��E"��� �'�'s''� 3�3 - w C'qSi.rM � <br /> Attech lour 14)copios of plens lor proposed work� Draw lo scale end noln the lollowing as anPlice�le. � <br /> • Property Lines • Centeiline o�stroet <br /> • Outline and dimensions ol all ezisting entl • Indicnte No�th <br /> proposed structures on Ihe lot • Show nny proppsed grndiny changes <br /> • Exisling end proposed�l�ilitles • Show measuremenls M <br /> � W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls lor Inapectlon shell be mede 24 hrs.in edven�e-phone 259•8810. � <br /> 2.All work ehell be peAormed In accortlence with ihla permil end current Cily of Everetl Desiqn end Conatruclion <br /> StAndards end Specificallons. <br /> 3.Call Locetlon Underpround Servlca 4B hra.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /. A�'Jf/' �//�LB1'S�,C� �.C�OSiO.t/ A.c�O cS.FOi,�/,�,t/%�9T�v�✓ C'OrVTXOL O <br /> /3^ To B6 l71�/:r �J G7�.PiCTi�O 8f/ Ti/E PU.BG/C� <br /> w��r ltiJof�r� h <br /> ,� f��/y AODi>io•� G.�U,et Gt�t/ 7�'i.f �f�.v��iNU A�e 08/31(lB6' 'fF�14FM OOORk2298 � <br /> I,�,cc�r��rc�✓ c� l��'AiN.vl-�S�S:�i„ Q ,��i.c��>_ J'.SH4G�[- � <br /> � <br /> �6Rr/i.c� f,L✓oTi���(' %�un��C wn��s f��E'n�ii . p�ro� l35.00 <br /> C^SH 535.� <br /> ' ACHNO�JL6DGE�dENT OF CONDI'ION3 <br /> The unders�yned owner/applicanl here6y ngrees to hold and save harm� <br /> less the City of EvereU hom nny antl all cleims lor Aamages. cosls� <br /> _� _ / eKpenses or causes of aclmn ihat may arise because ol u stallalwn <br /> �r xnd mamtenence of the rmprovement or othe� ngh��ol�wey use hereto <br /> �.� � �,�.o`'/��' <br /> ,�� � — _ � •-��' /�� apphcd fo� and lurlher agrecs lo remove same upon nohce Oom Ihe <br /> A �oved lo onslrucU n ' �e�e Cf{qland lo replace pub6c property damaged Ihereby <br /> � li <br /> � � <br /> � - � , 5 b�s' ��;�y.� I' �--_— � 3� �- <br /> FINA I .. TION ���e �_� �� � <br /> AOProved as Consiructed Si(P�ature ol AnP��cant Dale <br /> WOfiK AUTHORIZED BY THIS PERMIT MUST tlE STAR7ED WITHIN <br /> evrrell PUBLIC WOPKS DEPAR7MENi 180 DAVS nF DATF PERMI? IS ISSUED ANU 1NEREAFTER IS TO <br /> � 3200Ceder5lrcet BE OILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAV 8[ <br /> Everell.WA 9BP01 CANCELLED BV THE CITV UFON ANV STOPPAGE OF WORK ON THIS <br /> Phonc.259�8810 PPOJECT OVER 90 UAVS DURATION <br />