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� .n� <br /> s <br /> � <br /> �� � <br /> �y y J �/ ___' '.f�A'__ we�c won�vnrmn• a/ J ' 2.f-- <br /> y �y. ,�,� D8f@� ,�....y 9ao o.ai . � � Yy 7 i <br /> h� O AV[%�'CB�iOO FOI <br /> ��� PUBLIC WORKS PERMIT '°°"`"'"".". �- -- — <br /> ro,.,�.. <br /> 1� u���oo<<n vue 5 <br /> R'i '1. Bmnc�ow 3 _ <br /> 0� l7 Print or Type Only <br /> Q�°g � � �, �, �/� sP.ty .� y <br /> �?o : 3 // L�4 <+ /C� ,�'G�+-.u,',� d-o �e y <br /> � Zip Phona <br /> 9 H Owner Ma,'mq Adtlrena City . <br /> t'�� �;',"� <br /> �+d� APG I:anl Maillnp ACdrese CiIY Zlp P�ana � .... <br /> ��� _ , <br /> � r- �_ _ �__ <br /> y Deacnba PropaeeC Work _ <br /> - W <br /> ProleclAddroselllknown) '�� Yt�-s� Yr 7� 3 r/f rFo Yf 1 'J w yT 1i 9 H <br /> �� <br /> Atlac��our(4)copiea ol plene lo�proposed work� D�ew ro scele and note Ihe iallowinB ae aUDlicable: � � <br /> • Property Linae • Centedine ot street <br /> • Outline enA Olmenelone ol all exialing and • Intlicala North <br /> prOpo�ed qiructurea On�he IOt • Show eny proposed pradinp chan9es <br /> • Ealstinq and proposetl utllitlee � • Show measuremente M <br /> W <br /> 00 NOT WRITE B[LOW THIS LINE O <br /> J <br /> �� PERMIT CONDITIONS � <br /> 1.All calln lor Inspection shall be mede 24 hr�.in edvente�phone 259•8810. <br /> , I ! _.All work shill ha pedormed in accordence with thle permit end cwranl Gty of Evnrell Design and Constructlon <br /> r Standarda and SpeclfiwUonn. � <br /> 3.Cail Locatlon Undergraund Servite 48 hn,belore you dip.TOIL FREE NUMBEH 1•800�424�5555. <br /> i �� O <br /> I r ' � � c.'�.![r,�l. <br /> �, !}.Lc.' G iCZ/ri ��'.1>... /t' i <br /> i � <br /> � �ir � <br /> , 7-3� �/ <br /> �� ���� � I <br /> a <br /> � Li� '�� <br />� � ACKNOWLEDGEMENi OF CONDITIONS II <br /> The unAeBigneC owner/aOPlicant hemby eBraes W holC anA 5a�e harm� i <br /> '�� _ — less the Cily ol Everell Irom any antl all claims �or Oamagea cocts. <br /> eapenses, or causes o� action Ihet may ariea becaunn o� �n5lalletion <br /> and mainlenence ol I�e improvemem or ulher nq�t�of�wey use herelo <br /> apolieA �or and lurther agreea lo remove seme upon notice ��om the <br /> AppfOvetl IOf COnSUUCtIon 00tC Ci�y 2ntl IO�?P�0C8 pu61iC OtOperty d2meq9tl IhereUy. <br /> I <br /> 9NAL INSPECTION Date I Oale <br /> Approved as Constructed Signature ot ApPlicanl <br /> WOPK AUTHORIZE� 9Y THIS PERMIT MUST BE STARTED WITNIN <br /> PUBLICWORKSDFPPR�MEN7 tB0 DAYS OF OATE PERMI7 IS ISSUED AND THEREAFTEH IS TO � <br /> �A� 9200CederSlreet BE DILIGENTI_Y PUFSUED TO COMPLETION. THIS PERMIT MAY BE ' <br /> EveretL WA 98201 CANCELLED BV THE CITY UPON AN�STOPPAGE OP VJORK ON fH15 � <br /> Phone:259-6010 PROJECT OVER 90 DA�S OURATION <br />