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Date 11/i2/jl • ` � r�ou�wo,uv.�m��. �l�Z�� <br /> �k�s ..:� ;/�jQ� aiao o.oi� 91/27468 <br /> Aao��calian For " <br /> PUBLiC WORKS PERMIT ^�°:e,:�.:^. : <br /> �....oP�.�,�.a :— <br /> ' . g.l.n[eDue S �-� <br /> Print or Type Only �� ��� � - <br /> �' r e�r�.' - �r � <br /> �• r' �� N�M � •n N v) (�: <br /> Lvle E Blank Po Bo v66 cti.,r fr �ma aa�na " � 252-3326 <br /> Gwner Maihnq Atltlress m�. ti Glyi �� � � �2ip P�one <br /> r..� oo ��.Cj:: in > c+� -�ii� i� <br /> OwneL '•i _ -' ;. � � r' ' . . , <br /> ApplicaN Ideibng Adtlress Clly LP Phone <br /> Desuibe Propos�C Work . New SFR - 10205F <br /> W <br /> P�oleci Addmss�il known) �2? � � � <br /> Altach lom(4�copies ol plans br pmposed work�Diaw to -,:ale anE note ihe loltowing es applicnble: � <br /> •Properry lmes •Centetline ol strect /A <br /> •OuUine ond d�•nsions ol all evisling and •InCicale Norih V� <br /> pmpose0 stm.:tures on I�e lot •S�ow xny proposeE qrading c�avgcs <br /> •Eeistin9 an�proposetl ulihlies •Show mea5uremenl5 Y <br /> W <br /> DO NOi WRITE BELOW TMIS LINE O <br /> PERMIi CONDITIONS <br /> 1.All Cells lor in50ection s�all be mado 24 hrs.in atlmnca�phone 2$9•881Q � <br /> 2,All work shall be pedorm5d in ncrordance wilh��is permi�anC turrent City W Evmett DesiBn antl Constm<tion <br /> Standards enC SOecihcalions. <br /> �.CalllowtionUntlergrountl5ervice48�rs.bobroyouAig.TOLLFREENUMBEN�•800d24•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOK'LEDGEMENT OF CONDITIONS <br /> C� L�. T�cuntle�sipne40wner/pppli[anlhe�ebyaprcesloholCanasnvcharm� <br /> less ti�e Ctly of Everetl f�om any anE all claims lor Aamages, cosls. <br /> ///��� e�penses. Or causes ol acli0n Ihat may 2�i5e because ol inS�allaiion <br /> �,^^� V �_��_gl nna mainlenante ol tlie impwvemenl or other ri9hDol�way use herelo <br /> l.. �1� 4X17... ✓ applietl lo� antl�w�her agr¢es�o iemovC same uPon noilce Imm Ihe <br /> App�ov�r GonsimCbon Date Cily Tntl Io teplaCe�ublic pro�o��y damaged��e�eby. <br /> �� l� ���� 7�8�� �� r�l:�i � <br /> � �%' 9/ <br /> i�i i cTi N . c <br /> APnroved as Conslructed � 9ig'r1�we ol Ap0licant Dale <br /> I� PUBUC WOHNSDEPARTMENT WC/�K AUTHOl712ED BY THIS PERMIT MUST BE STARTED WITMIN <br /> 7 9p0pCetlxr51reo1 100 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS i0 <br /> Emrett WA 9BP01 BE DILIGENTIY PURSl1E0 TO COMPLETION.TNIS PERAIIT MAV BE <br /> Pnona�.259�08�^ CANCELLEG EV THE CITV UPON ANV STOPPAGE OF WOPK ON TMIS <br /> PROJECT OVER dJ DAYS DURATION. / <br /> ___- '_—_ —_ . —'—_.__._ ' <br />