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�j,, / <br /> De�C 1Y-1-92 wei�cwm��rvm�n /�' 2 <br /> Ap0liCellan For , <br /> eia�o�oi• 38927 <br /> PUBLIC WORKS PERi1AlT °°°r�:.::'°• . <br /> �.,..�P���.P.,�a <br /> Print or Type Only TO POSTING_S-a�-93 . e.�.�«a�. s �lJ� <br /> .lerry A Weber PO Box 1744 Maryaville NA 98270 659-7671 <br /> Owne� MaiengAtltlress C�ity Zip � P�one <br /> Snterstrom Nomes PO Box 190 Lk Stevens 98258 334-1686 Earl Sacerscrom <br /> ApPlitant MaiLn)Atltlress City Zip �'�ane <br /> DescriCe ProOosed Wark new' hoUxe <br /> W <br /> P�oject Atltlress lil knownl -S/S— FuCtc�l7 � <br /> Allach IOw�4�COpms ol plans lor O�OPoS¢d wotk�Drdw lo Swle anE nOlo Ih0 lollowing d5 apDbCdble�. � <br /> •Proparty Lines •Centetlme ol slreet /A <br /> •Outline anC dimensions ol all eRisbng nn0 •Intl¢ato No�l� V� <br /> p�oPased slructures on t�e lol •S�ow any propo5ed gratlin0 cnanges <br /> •E�ist�ng and proposetl uU�ilies •Show measuremenl5 M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CO�01T1 JNS <br /> t.n��wns lor inspection shan bo mede 2a nrs.�n a0rance-phone 259•8810. ^ <br /> y.All work shall be pedormetl in accordancx wll�If:is permit entl currenl City ol Everell D¢sign end Cons�ruclion � <br /> $tentlards and SpeciliWtions <br /> 7.CnIILocationUnCerprountlService4Bhrsbalurayoutlig.TOLLFREENUMBEHI•800�424•5555. � <br /> � COrI/JCC7�' /`00J� �CfJ VUF✓nSJc��f'S /i7'fo EiUi�c�i.�J O <br /> �S/[/c' S�!<lc'Y'. <br /> '�^ <br />' Y/ <br /> O <br /> a <br /> ..��/� ACKNOWLE�G[�dENi OF CONDITIONS <br /> /i tv <br /> . T�e untle�signe0 owner/applicant he�eby ag�ees to nol;f:me sa�c��.unr <br /> less I�e Gly ol Ewretl Irom nny end ah e�0ims tor i�ama9es. msls. <br /> �/ / e�penses. or cau505 0l action ihal mny arise because ol mslallalio�� <br /> c�f},'���Z /.�/C/p2 and maintenance al I�e impmvemenl or ciM1er nq�Fo4way use he�e�n <br /> �IG G"7 d1/ � apphed lor and lurlher agrecs to remova same upon not¢e Imm Ihe <br /> nnmo��a m�coosv�cuo� ������ Cny anN to repL¢e publm pronerty damaBeU Iheretry. <br /> U � ) <br /> ..��'��'� f'�/'S�3 / p <br /> nNni Ir:>v[C7iON Dn10 /�"2a"��= <br /> Ap��.n .�G.u.Uinsbu<letl alu � ol ApPt�ca 1 Dalc <br /> PUdLIC WORKSDEPARTMENT J �N �UTHORIZEO BY THIS PERMIT MUST BE STFRT=D WITHIN <br /> � BO OAYS OP �ATE PF.RtdIT IS ISSUED AND 7HERE?FTER IS TO <br /> N'� '11W Qder Stwnl p�DILIGENTLV PURSl1ED IO COMPLETION.TMIS PFRMIT M4`:Pi <br /> EJb�n E�ereit\VA�J8201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WO�iK ON iH15 <br /> Vnmc 259�BA10 PROJECI OYEN 90 DAVS DURATION. <br />