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Hn � <br /> A� � <br /> C �� <br /> 'yi H!n � --- - - <br /> —_.___ . _____. . <br /> C _ _ ' <br /> �'y� Date�L9� �...,� wo�K won�w�mn• <br /> �y� APPIiCatian FOr 9iao.Oro� . 9��"� 7yJ / — J7�Z J-'- <br />� �: � PUBLIC WORKS PERMIT �����<w�,..�•. <br /> � .a„��.. _ <br /> oH <br /> �.,,.00�.s.o„a s <br /> .�.i�g Pnnt or Type Only e.�.��.n�. s <br /> �I]Y (� <br /> yH <br /> t+ . _...� � ,�003 �/ C�-c�a..�-x.. /« ,�'� S Piz y ,? Ya a7o � <br /> ty y y Owner MaiHng Adtlress City 21p Phone <br /> O H <br /> O N ,. <br /> � Applican� Meiling Address Cily 21p Phcne <br /> ��� - <br /> Doscrlba PropoaoE Work � ��-.�-�� <br /> Project ACCrese Of knownl �yr 1� rt= �� 3�_4f s s o y�1 �7 ,,. yr ii y � <br /> Atlach lour(4)coo�ea ol plens for proposetl work- Draw to scale anU note Ine lollowing as applicable: � <br /> • Property Linef •Cenledina ol street � <br /> • OuUine and Eimenaions ol all exlelinq and • InCicate Nort� <br /> pro0oaed efructuroe on tha lot • Show eny D�oposeE graCinq chanpes <br /> • Exiatlnp end propoeed utlll�lee � • Show meesuremen�e � <br /> DO NIIT WRITE BELOW TMIS LINE � <br /> ' 1 PERMIT CONDITIONS <br /> ' ' 1.All calla for Inepectlon shall ba meda 24 hrs.in edvance•phone 259•8810. � <br /> � 2.All work shell be pertormed in accordance with thia permil end cwrent Gty o�Everelt Desiqn and Constructlon <br /> '�' StantleMa end Spl+cificationn. <br /> 3.Call Locatlon Underground Servica nB h�s balare you dig.TOLL FREE NUMBER 1•800-4245555. � <br /> '�' <br />� " �. �i. Le�B2�i �'.ln•�(� /_'.•�G'r.ler.��� O <br /> i <br /> 1_I .��; � <br /> , V��- �-,� -; , <br /> i'� <br /> - O <br /> �_� a <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br /> 1 — <br /> The unCersigneA owner/applicant herehy agrae i lo hold anC save herm� <br /> � les! ihe Cily o� Everetl Irom eny antl all cleiins lor damapei coets. <br /> - . . e�penses, or ceueee al attmn �haf may atlle beceuue ol msrellation <br /> antl maintenence of Ihe improvement or ol�er ng�Fpf-wey use herelo <br /> 3ppIIBtl fOf 3nd �UrthOr agleB9 10 rBmoVe 9Bm�) up011 nOiiCe Irom the - <br /> ApproveC lof ConstfUttlon Date Cily antl to replace public proPeny tlameged t�nleby. <br /> i <br /> °INAL INSPECTION Oate � <br /> Appfoved eS Cons�fut�OU Si�na�ure ol ApPli[an� Dale � <br /> � PUBLICWORKSUEPARTMENT .V09K AUTHORIZED 9V THIS PERMIT MUST BE STARTED WI�HIN � � <br /> 7200 CeAerSlreat 180 DAYS OF DATE PEFMITIS ISSUED AND THEREAFTER IS TO <br /> EverotL WA 98201 BE OILIGENTLY PURSUED TO COMPIETION. 7HIS PERMIT MAV BE ! ' <br /> Phone:YS&9810 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON 7HIS � � <br /> I PROJEC70VER 90 DAVS DURATION. � <br />