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��_ <br /> /✓ <br /> �L � <br /> Date_��1- �il �� �� P�S���'��] � I. ��: �. . .,..,���� � � �, <br /> - T L u�aa o��: . _!�'. <br /> ApphcationFm -- - <br /> � � ro PUBUC WORKS PERMIT �°°'""`°„'�°° 5 -- <br /> � ,o�a�.ee <br /> p S i.,ssnooi rcr�em 5 <br /> C N — <br /> y y y BrirnrP D�. S� _ <br /> y � Hf; Print or Type Only <br /> � H 'A <br /> � y � ,. 2,,•n vn (oOCy Wdsh'nUE-cn�v2. L=vc.rett �Zc3 3S3 -7z.c:•?� <br /> y t� �'�'1 ��� { �'{ ZiP Phone <br /> C ZO � Mailing Atldress w <br /> Owner <br /> o H i� ���'�_L-_���l.� l.� i3 l UC.�7 <br /> z n � , 7 c� � l l-�i� � ��c.cc� ��--" -- <br /> .. ce Sv0 't'�� I�on'ltJS 1�. (.:2� S� �__�� ��„„�, <br /> H � � pplicanl Mailing Atloress CRy �- � <br /> �i � —— '_._— <br /> H <br /> M t�� Sr�' <br /> Q N H Describe Proposed Work _ _ _ <br /> Rtly <br /> � wr � <br /> � � <br /> Project Address 1�1 knownl � ��� ���'��''�� S� — � <br /> �� <br /> Attach tour 1�1 cop�es o�Plans lor proposed work�Draw to scale and nnte Ihe tollowing as apPlicab�e�. � <br /> • Property Lines • Centerlme ol streel <br /> • Indicate North <br /> • Oulline and dimensions ol all existm9 an0 � Show any p�oposed g�adm9 cnan�es <br /> proposed structures on Ihe lot • Show mcasuwmrnls M <br /> • Gsi51in9 and p�Oposed utihties ����� <br /> DO tJOT WRITE B[LOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> t.All wlls for inspection shall be made 24 hrs.in advance-Phone 259•8810. <br /> 2.All work shall be pedormetl in accordance with this pennit and current City of Evmctt Des�gn and Conslruction <br /> ���. Standards and Specificaticns. � <br /> � _ 3.Call Lowlion Underground Service 48 hrs.before you aig.TOLL FREE NUMBER 1•B00•424•5555. <br /> � � \ <br /> i� <br /> �{� �.iC Gr ; vc:..i�� ae.c:e.s5 �SJ \YJS��', ��c,Li, � r \,L — �'- O i <br /> I � r <br /> ��=� \�(' h � CJ ( �3f .>�.« i5 il'1-t�S�.. E�.C. -t�-,rC��� c>� �.izt�� . � � <br /> V/ � <br /> � �� � i <br /> a <br /> �, <br /> -_ , <br /> ACh:NOVJI.LDGEMENiOFCONDITIONS '� <br /> � � lho�indersignetl o�vnar,�applimnt hereby a9wes to holA and save ha�m <br /> � w1�' - — less Ihe Cdy o! Everet� Irom any and all daims tor dama9es, cosis <br /> ' /� �xnC�5C5. Of CdU5C5 O� 0C1i0� Ihdi n13y 2li50 bCL2U5f 0� installatio� <br /> �� . / /�f` ^/,^���e� ,L/ / and mamtenance nl lhe improvemenl or olher ri9hbof-way use hereto <br /> �� C/ �� I —����� �pplied �or and turiher agrees to remove same upun �olice Irom Ihe <br /> I '1� AppwveA r Conslruction „ Date �i�y,and to iep�aceIq1ubhc n�operry damaged thereUy. <br /> ( //� C.�i.rt�1-..1.2r A.��LLf�✓ji V <br /> � � � i� /�/9��. ,�� �� , -/4 � 9 �- I <br /> �' Uatc I <br /> FINAL INSPECTION �� Date Si�ur ol AnPI caN <br /> Approved as Construcled <br /> WORK AUTHORIZED RY 1HIS P[RMIT MUST BE STARTED WITI <br /> L�"7 PUBLICWORKSDEPARTMENT 7g0 DAYS OF DA7E PEFMIT IS ISSUED AND iHEREAFTEF IS TO <br /> � 3200 CeOar Streel BE DIUGENTLY PURSU6D TO COMPLETION.THIS PERMIT tdAV BE I <br /> Evereil,WA 98207 CANC�IL[U BV 7HE CITY UPON ANY STOPPAGE OF WaAK ON THIS <br /> Phane�.259-8810 PPOJECT OVER 90 DAVS DURATION. <br /> � <br />