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, . �/�'`l��� � <br /> I 9 � - r- �' FuCLc Wo��vPVmit• <br /> l�l�` � ' ... �, � � p MndtSU�.� � emaoeoi ���� <br /> Date� <br /> AVPlicationFor ��� � �r p„pi,cworwsvoe 5 <br /> PUBLIC WORKS PERMIY i��a�F�° <br /> H CI H i�a:nrai reoFa�e 5 ��— <br /> � rl� o,,.,...ru�r 5+�-6=—-- <br /> S• H <br /> io :� x <br /> C H Print or Type Only <br /> > �3V� � <br /> y4 <br /> �[H �� � �„ r10 �,, � I I �� ►��.�'�' � Z <br /> " � � a N �,�Y <br /> — Z��, vh��,� <br /> Mailin9 Addres� �,. <br /> ow��� �ss c�ao5 <br /> � fAH /� Q " <br /> � t f� �l e � ()flp Z�F Phone <br /> x �� ��.Ll-- �dtlress ���Y <br /> [TJ O � ppP.icaN —_ <br /> C H 7 b�'V <br /> 7 � t7 �h\ I.t.' _ _ ^ ' �!! / _ <br /> �� � Describe Pioposetl Work / , � - , , ��. i� -:.�•__.� ' <br /> —� <br /> 7 <br /> Z H � � ��� �i-_ � �✓-- �_ <br /> � y Z _.-.�-=_-�--- W, <br /> g d y �� ,4c ,4�ov G— _ — � <br /> Proiecl Adcress(il known) � <br /> �� � � <br /> z y y A:iach lour I4)copiCs o�P��ns tor proposed wo�h�Draw�o°������°�oo1a�� �terline ol sbert �� ' <br /> y p q� • ProneriY��nes ntliwle North <br /> � • OuUiae:,:�d dimensions:�I all r,zisting anA Show any prop�sed qr.�Ain9 ch�n9es � <br /> P�pp�;ed slruclures cn Il�e lol • Show measurements <br /> • Existina��nd vroposed ut�lilies � <br /> 1 DO NOT W ELOW 1HIS LINE <br /> I ^ <br /> I �_ PERMITCONDITIONS I <br /> 1.All calis br insD�ction shall 6e madc 2a hrs.� van�c-P��on�259•88 <br /> ��1 p qll work shall be Pedermed in atcordance this pennil and cw�md City of Eve�eU Design and Ccnslruction � <br /> Standards and Specifications. <br /> 3.Gall Location Underqmund Service 48 hrs.betore you difl.TOLL FREE NUMBER 1-800'424'555 . O <br /> i � , ._- ,,c ?tJy .�=/ <br /> .� ;'.�! �/ %�/J -� •- �'_� <br /> '�..� / ��.'1` <br /> r , ���' � <br /> - � -���,ti�s��.,;� �� - -� r � <br /> 4/ /� � <br /> �._- ( � N <br /> 1�1"j =1�-c --S,� . - � ', � �� � <br /> , � <br /> i-o_� �- <br /> �lu ��' � ,- I�. <br /> �{-� � { i, G�, , <br /> �� . 1 AGKNO�NLEDGEAILNT OF CONDITIO�dS <br /> � qr�\� � �ffPA�l <br /> trsignPd owner/app�iwr,l hereby�9rees lo haid;'i"�"'°°�'�fp1� <br /> � __ � ���� �3 C'dY ol Everelt Irom anY and a� r se 6ecau�r.�of install.�lio�� <br /> ._5. or causes o� aclion ihil m�. <br /> and mdin'endnce ol Iho impro�ement or othe� ���9���'`� :',�ce�lrom Ih� <br /> '--�� ��" � �/'��/ app�ied for 2nd furlher a9rees lo remove same ��P�'� <br /> __: �. <br /> — � '` � � ate Ci:y and lo replace public property Aamaged Ihereby. <br /> APP�a P� �pr Cpnslruction <br /> .� � - 0� =7=�� <br /> Datc • <br /> Dalc <br /> RNAL WSPEGTION ignat of App�icant <br /> qpproved as Constructed c_�AUTHORIZED BY THIS PERMIT MUST 9E SIARTED WI7H�N <br /> � p�g��pWORKSDEPARiMENT 100 DAYS OF �ATE PERMIT IS ISSUED ^.ND THEPEAFTER IS T� <br /> � 3200 Cedar Street BE DILIGENTLV PURSUED TO C061PLFTION. THIS PERM1IIT tdAY [3[ <br /> Everelt.WA 98201 CANCELIED 8V THE CITY UPON ANY STOPPAGE O!",•JORK OV THIS <br /> ' Phona 259'36�0 PR0.1[CT OVE�7�0 UAYS DURAiION. <br />