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Date�J-�'��7 ��o�,�wo,�,��,m�. 7/86 <br /> AppliCetian FOr Biap Deoi ._ 8-% �.�.,£__ <br /> PUBLIC WORKS PERMIT Pu�M1CWorh�Fee -- <br /> Tot�l Fee a <br /> Lee��pol Poe Ptid S_ <br /> Bei�nce Uue {_� <br /> Print or Type Only _ <br /> 2�,b�,-� ou�vur � � Y .3 ���_ F�� ,,��v 9� 3 asa-y�,,� <br /> Owner 6lailing Address City Zi Phone <br /> Sa vV� C. <br /> Applican� MeiGng Addrr,ss City Zip Phone <br /> Describe Proposed Work _^N(��.1 (,�((�!e Ylal[�.� <br /> Prolect Addrese�il known) o+-O � <br /> �c OR. � <br /> Attech lou�(4)coplos ol plens lor proposed work• Draw to scele and note the IOPowlny os applicable: ��� <br /> • Property Lines • Cente�line of st�eet �A <br /> • Outline and dimensions ol all r,xisting end • Indicate Nor�h 1'd <br /> proposeA atructuras on the lol • Show any proposed grading changea <br /> • EMisfing antl proposad utilitie�s • Show maesurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All cell9 lor inapection shell be mede 24 h�s. In edvance•phone 259-�81 5. � <br /> 2. All work sha�l be perbrmed m nccordance w�th Ihis permit end current City of Eve�elt Design und Gunsln�ction <br /> :itendards end Specilicallons. <br /> 3. Call Loce�tion Underground Service 48 hrs. belore you dig.TOII FREE NUMBER 1•800-�{24•5555. � <br /> O <br /> � <br />� � <br /> O <br /> a <br /> ACKNOWLEDGEME'�T OF(;ONDITIONS <br /> ______ The untlersigned ownei/applicant nureby agrees lo hold and save harm- <br /> - / less the Cily of Everef Irom .�.y end all claims lor dameges, co:.a, <br /> � � eapenses, o� ceuses o�. eclion Ihat r�ey eiise bec�uae ol inr.tnlietion <br /> -�% �� � �' � end maintenance ol the impro�emen r other riphFal�wey use hereto <br /> � �— eppi.ad lor and further egrone to remove aeme upon notica from the <br /> ed for Dafe Cily and lo re�lace public p-operty�1^mnged thereby. <br /> � �/ 1 �7 //�� ' <br /> FINAL I SpECTION Date �5%�i/ �% �L_. <br /> Approved as Construded S�N�Uf9 Ol+k[Iplicent Date <br /> cverett PUBLIt,WORKS DEPAPtMENT WORl; AU"�'ORI2ED BY TNIS PERMIT MUS' Bl STARTED WITHIN <br /> � 3200 Cedar S�reet 1B0 DA�S l,J PATE ��ERMI7 IS ISSUEL AND THEREAfTER IS TO <br /> Eveiet WA 98201 BE DILIGGN'i LY PU��UED TO COMP�ETION. THIS PERMIT MAV BE <br /> Phcne: 259�8815 C',NCFLLEU -�'.�T�+.'. CITY UppN ANV SiGPPAGE OF WOf7K ON THIS <br /> PHOJCCT OVFR 9U DAYS GUHATION. <br />