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Date�l/ ' ��,�,�,�:wo,w.�r,m,� �� — �tiZ_ <br /> P APPlicahon For mn�� o�n� . �.���GG �Y <br /> L� <br /> F'U�.IC WORKS �'ERMIT -���,-���w�«.FCe-- __ <br /> tOlPlfpf �— <br /> O <br /> � .eif Appl �Ce FIiU S� <br /> Print or Type Only � n o��'°`e°"" s ��y- X <br /> �n o <br /> M <br /> l� � <br /> � <br /> Dti.vl �,�Q���, a�'j :iS ?'7c7 �hs e�t=-7� �,Ei�rr«" �a'i�-Y .SGG-3s"L3 <br /> Owner � .o-t- .-�IdD�ling Address City Zip Phone <br /> P O L•_ 3 3 N <br /> .-I ocda ¢ <br /> g � V <br /> U Lc/.tJE�" <br /> Applican� r Mailing Adtlress Ci�y Lip Phonr. <br /> Descri6e f'�oposed Work _ SiTE �.ec--.���,�,ri�w/ .vdie.r Fo.G `��'�s� �� � <br /> 4 F�'e %-'�e �r: �.e i � 'uCd G.n ' /:p. . ' <br /> ---- �'— '�'-- - <br /> — _— -- -- �1 <br /> Project Address�il known) 30U.3 L�I LrA.fi!l/ /"�O .____ __ � <br /> � <br /> A�tach lour(AI copies ol plans lor proposed�vork� �raw to sc[Je and nole ihe lollowing a,apphcable�. �� <br /> • Proper�y Lines • Centerune o�alre^t � <br /> Y Outline anA dimensions of au existme�nnA • Indicatr. Nmth <br /> proposed Slruc�ures on the lOt • Show any piUposod yiadinc�change; <br /> • Exisling and proposed utililies • Show meas�iements � <br /> DO NOT WFITE BEL��W THIS LItJl� � <br /> PERMIT CONDITIOVS <br /> 1.All calls lor inspeclion shall be made 24 hrs.in aCvance•phenr 259•881Q. � <br /> 2.All work shall be pertormed in eccordance with ihis permil and r�,:nont Ciry ol Everelt Design and Conslruction <br /> Standards and Specilicatlons. <br /> 3.Call Localion Undergiound Service 48 h�s.belore you dip.TOIL FREE NIIMBER 7•800•424•5555. � <br /> �l. .J-!.l<'-� �lfr(( �ia ldJ:� �� �� ��J:.�, �� .:, �1/�� �rt:�. �/.�rJ J/�"I� l.i�, O <br /> �� ,�i� Et:e'.z�•tf /��.�'.l-'�:� ld�n<�.� d�.� oiJi./ y-i��- I/ <br /> S. .1.!<� l3taa��n/� C/Yf'� .�CC�I� �a�1L %'�A.N•��:�t/ �/�r]7r ([rfJ;�t':'�:i`:� � <br /> C% U (� / � <br /> i��G1il /IPy/a�e(C� �c L2,<</,r�n�e�;f" ,,� �[r� � f4e-:'��.,� ln� <br /> O <br /> t7.�c0�' c:�iZ.• :, L`i��<< �,.� ;Or�c ._G,vt �.� ..� . <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thc undersn,7ned owncUapnLce�nt hereby ayrees lo hold and save harm� <br /> — less the City d Everelt Irom any and ill claims lor damages, coste.. <br /> expenses. or causes ol action Ihat may arise because ol installaticn <br /> �_. �"L/ i o and maintenanCe ol the im rcvemenl or uther n hl�ol�wa use heret0 <br /> %�` ��r�i ���� /� applicd br and lurther a9rees to remove same upon not ce Irom ihe <br /> Approved�fStConsir�iction Date City anJ to replace p�bhc property damnged Ihereby. <br /> / .-���,1 � �1:�="�� !/a. ���� ,,,��( (��,..�-�C� �/�9��/ <br /> P�NAL INSPECTION� �- ' Date <br /> Approved as Conslructed ' Siyn,ture of licanl Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHURIZED BY THIS PERMR MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEFEAFTEfl IS TO <br /> Evorxtt,WA 98201 BE DILIG[NTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJFCT OVER 90 DAVS DURATION. <br />