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-- - - _ <br /> - -- - _ _ _ __, - <br /> - - _ .. ... J <br /> Date�9�' ��o��wo,.,P�,m��• _��__t L(/�a��—�. <br /> emo oea�..----I�'if ",` ��. <br /> Appiication For <br /> H PUBLIC WORKS PERMIT °°°'�°w°��°`°° � - <br /> y�� '� toie�Fer ' <br /> �9� I Lesa�oo� ier Va•e 5 <br /> �.".�x ' 6aiance Due S �� aO <br /> a y y i Prinl or Type Only -- <br /> H �r3i � ��✓ d ���} �,r � G�Ulv1 � u �cfG�4. ����I-5 �� li/�.�ii�nGtl.� :!L /{11an�'�O�c.. �f.iatL /r��y.i <br /> J <br /> K o � t'�l f �i iNra �c��Tl�Preko�� s'�, � l4y�l S�n��,.,1,�?�L ni = �_f:vd 4,{o�j ���' �93�,0 <br /> H x1 <br /> � H� �, Owner Mad g Atltlre55 Cdy Zip Phone <br /> y H i <br /> z � c vt/k c � -�, Grinn,LS <br /> � y d ��., qpplicant Mailing Atldress Gt Zip Phon? <br /> OH i <br /> '� �O �1 1 � <br /> � Describa PwGosed Work I�f IY C�i f.mn �(– f Aaf/6PI�/ �/_ �� <br /> �V n <br /> z r,� I — <br /> Cyx � � <br /> g N H LLJ <br /> � d� r7� � <br /> � �� '�I Proled Address Id knownl � ��� !�/ P�� � �� �'! p — — <br /> Z �J V7 � AltaCh lour(4�COPieS 0�p�ans lor propoSed Work-Jraw�0 Scale antl note Ihe lollowing as applicable �� <br /> �' O� • ProPerty Lmes '�`--- . . • Genterline e1 sheel Il'!�5/';�� .. ..-� .. . � <br /> • Oulline and dimen5�ons af all exisl nq �m) • IndiCalC No�ih � <br /> proposetl StruCturrs on Iqe lot • ShOw 0ny proPoscd gredrtiO!Zttl�rql4 <br /> ' • Eeisiinp artl proPoSed u���i��"s • Sbow mr�3�mipmeNS i.ij(j . _ . , � <br /> � <br /> ' ooNur �vHiTt E+��owniisur�[ ;E��H Ii5.G0 O <br /> � <br /> I � PERMIT CONDI110NS ;�. c•.F.��,i 5�:, ��..n <br /> � � I 1.All Ca115 tor inspection Sh211 be made 54 hrs.in ativance-phonr'1rJ9•HS�O. C{�..UW�� �� -��.�I�� � <br /> �C 2.All work Shall be pedormed in acCortlance with this permd antl current Cdy of Eeereti Uesig���t�,Con;in�Ajon , <br /> Standaids anA Sp�uhrations <br /> �r - -� 3.CaII LOCa�ion UndciqrrunJ 5cn.c���:"r, t.r, b��lonr 7c'.i C �: TOLL FREE NUM�ER �•8��•4'24•rJ$$$. � <br /> �� � � <br /> .... .,� O <br /> �r. '� � <br /> � � <br /> '�^t.wo .. _ O <br /> e .._ a. <br /> �.�� <br /> � �� I � ACKIJOVJLEDGEMENTOFCONUITIONS <br /> � <br /> ihe undersiyned owneUapplicant hereby agrees to ho10 ana save harm� <br /> I �� less the Cily ol Everelt Irom any and all claims for damages, costs. <br /> , C:'����p' ezpenses. or causes ol action thal may arise because ol in�tallation <br /> 8 O� pD ane main�enance ol ihe improvement or olher nghbo�-way usc herelo <br /> Z � applied fa and furlher agrees lo remove same upon notice Irom Ihe <br /> �'� Approved tor Const .tiqn Date C�ty anA to replace public property Uamayed thereby. <br /> �' � _� <br /> ��%���.. 3 ii � z /-/'-�_.�`.,'(,. /,�/ <br /> FINAL INSPECTION Dalc (����'�^"�� �""f� ���F _ SJ <br /> � ApProved as Conslructed SiynaWr, ol Annlicant Dale <br /> WORK AUT�HORIZED B� THIS PLRMIT MUST B[ STARTED WITIiI1J <br /> cv�rrtt PUBLICWORKSDEPARTIdENT 1y0 DAYS OF DATE PEf1M1T IS ISSUED AND THEREAFiER IS TG <br /> � 3200CedarSireet B[ UILIGENiLY PURSUED TO COMPLETION. THIS PENMIT MAY �(' <br /> [vcrclL WA 98201 CANC[LLED BV THE CITY UPOIJ ANV STOPPAGE OF WORK ON 1Hi5 <br /> Phnne:2fi9�A810 PHOJCCT OVCR 90 DA1'S DURATION <br />