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Date��U ' ' ..� r�m�owa�k,re,mn. <br /> B�ao Dept.• �S�S S <br /> P.ppliwtion FOr <br /> PUBLIC WORKS PERMIT '°°'""°'""'° <br /> Talal Fea 5 <br /> y�� les5l0�1 Fee VmJ �+ <br /> OaianceDue 5 <br /> p�x Print or Type Only <br /> � H <br /> ayv� <br /> y �H Rn ) Fo��/�—�Zi D�F � r���, �-re. F--,�r�a-F� ��'�2n � �`� � - �r G� c <br /> � y� � Owner MailingAtltlress City Zip Phone <br /> � y� c � <br /> 5 Z 3 App eaM Mailm9 Adtlress Cily Zlp Phone <br /> t7 O[�7 <br /> H C7 <br /> OH <br /> � �t7 Descrihe Proposed Work <br /> /� O <br /> y�V � <br /> Xy� �� Ny W <br /> g H o7/08' /1�o„�n� �' �� <br /> n CJ p1 Project Address lil knoH'n1 <br /> � L"t" Atlach lour(4)copies of pians�or proposed work- Draw to scale and note the lollowing as applicable: � <br /> � • Centedine ol sireet ♦A <br /> y yO� • Property Lines <br /> • Oulline and dimensions o�all eaisling and • Indicate North V� <br /> pro;,osed siructures on Ihe�M • Show any proposed 9radin9 changr.s <br /> ! Existina anA proposed utilities • 51-,ow measuremenls /M <br /> W <br /> DO NOT Wf717E 6ELOW T1115 LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor inspectioo shall be made 2a hrs.in advancn-phone 259•8810. � <br /> .,� � 2.All work shall be pedormed m acwrdance with Ihis permil and current City ol Ecerett Design and Co��slruction <br /> � � Standards and Specdications. <br /> '� 3.Call Location Underground Service 48 hrs.before you dlg.TOLL FREE NUMBER 1-800-424•5555. � <br /> N r. I�V�l–I L ��/C�ZKS �l f( .�EC:...�'.� rL�7� <br /> '� O <br /> � <br /> —..� �-��«C �'1 �c:` <br /> 7- z C� —`_',o � <br /> w,,,� -- l _/ <br /> { � � O <br /> a <br /> ¢ � <br /> ACKNOVJL[DG[A1ENT OP CONDITIONS <br /> ihe undersi9ned oa�nednpphcanl hercUy afl��es Io hold and save harnr <br /> �'+ I�ss Ihe Gty ol Evere�t trom any and all clauns lor damaqes, costs. <br /> expenses. or causes of ac�ion Ihal may arise because ol installation <br /> and maintenance of ihe improvement or other n9h4ol-way use herelo <br /> applied lor and iwther a9rces b �emuve same upon notice Iwm the <br /> � APPwved lor Cons�ruClion Date CitY��'�to rel,'��:�'P���hc P��Pcrty Aamaqed IherebY. <br /> PINAL INSPECTION Date — — <br /> Appmved as Construcind Synawre ol ApPlicanl Date <br /> WORK �UTHORIZFD BY THIS PERMIT A1US7 BE STARTED WITHIN <br /> evereU PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PEFMIT IS ISSU[D AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT M�Y BE <br /> Evcretl.WA96201 C4NCELLED BY THE CRY JPON ANY STOPPAGE OP WORK ON 1HIS 1 <br /> Phona 259�6tl10 PROJEC7 OV[R f70 DAYS DURATION. i, <br /> I <br /> � <br /> � <br /> � <br />