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„A ,.°; <br /> � <br /> ��a � <br /> oa � <br /> ^y�,� Date,y�Q � `` �.:.� r��i,.,.w,.,..r�,�„i. --------- <br /> fC O APPlicolion For n�nu oew s_ ._-_--—__—.— <br /> ��� Pll3LIC WORKS PERMIT °°^°<W°,�.�° - ----- — <br /> � � .o,.�Fes ° s_ — <br /> � Le�a Au�l fea Fu�1 S <br /> y Print ar Type Only o.a��,o�. S <br /> OH <br /> ��g <br /> �Hp�yy � <br /> r�f.� B�E�NG �,'o. 3003 w. C'as+Nu RD ,, eV�2c�' 9�u�/ .�'lZ-o8�/_ <br /> y Owner Mailin9 Atltlress Cily Zip Phonc <br /> M <br /> p�� TII� QOLr/N6 CG. �00,3 I/✓. L.!}-JINU �0.� EVCh•<'TrG)��/ '3Y2'�Q��I <br /> � Applican� Mailinn AdAress Ci�y � Lp � Phune — <br /> �� Describo Proposed Work ;'� �'�K �P .�UJL�/N( �X�AvJ3/e�✓ �l�G• YO—s.3 <br /> w <br /> - - -- - W <br /> on '`� . CA.S/,vo I� �' � � � <br /> Prolect Address lil Knawnl � 3 �-✓,) L' V T/T� W'¢, <br /> Altoch lour(41 cooies ol plans lor proposetl work- Draw lo scale and nole the followin��s applicable�. � <br /> • Properly Lines • Centedine al slreel � <br /> • Oulline and dimensions ol oll eMretin9 antl • InL�cata Nor�h <br /> pmGosed structuros on Ihe lot • Show any proposetl 9mtlmp changes <br /> • Exisling�nd proposed u�ililics • Show measuraments � <br /> � DO NOT WFITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> ���j 1.All calls lor inspectlon shall be mede 24 hrs.in edvance•phone 259•881 O. � <br /> 2.All work shall be peAormed in accordanca wilh lhis permit and cunent City ol Everelt Deslqn and Conslruclion <br /> t Stende�ds and Specilicntions. <br /> C� 3 Call location Underground Service 40 hrs bnlore you di9 TOLL FREE NUMBER 1-800•424•5555. � <br /> ���c. �acz�.s 1/�z-�»,.<� �Jo� ��ti-c�c.'� O <br /> � ���/ � <br /> � `�y`���,�•�,� I/� <br /> N♦ <br /> I _� O <br /> a <br /> 'i L� <br /> t�CKNOWL[DGLMENiOFCONDRIONS <br /> U� The unders�yneU owner/apt�licanl herchy aqrees lo holtl and save harm- <br /> less Ihe CAy ol Everetl Irom any antl all claims for tlamages. cosls. <br /> I e�punv:s. or r.auses ol acboi� Ilml mny anse Uecause ol mslallalion <br /> miA mainti�imnr.e ol �hu unpmvement or olhei n9hFobway use hmelo <br /> ;�ppiu,n !or anJ lurlhci a��rues �o remove sume uPon no�ice hom ihe <br /> Approved lor Con5lruCiion D"Jin C�IY.��'.d Io inPlaCe P��Ubc pwP�'��Y ddme9ed iherrby <br /> FINAL INSPECTION ����e -- �- --�-- -- — -- <br /> Approvatl as Consl�uc�ed ;uin dwc of Fupiir„�nt Dale <br /> WORN AUiHURIZED OY THIS PER�dI( MUST BE START[D WITHIN <br /> rverell PUBLICWORKSDEPARTMENT 160 DAYS OF DA1E PE�MIi IS ISSUED AND THEPEAFTER IS TO <br /> � 3209CoderSlroet BE UILIGE.'IiLV PURSUED 70 COMPLETION. 7H15 PERMIT tAAV BE <br /> Evorelt.WA9B201 CANCELLED BY THE CIiV UPUN ANV STOPPAG[OF WORK ON THIS <br /> Phano'259�9810 PHOJECT OV[R 90 UAVS DURATION. <br />