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���C H�1�`�' rw�i�cw��,ksro�mn. <br /> APPlicalion For ��nn Dn�n .=i� / .��G ,S� 2 j <br /> PUBLIC WORKS PERMIT ��„���w���,�« - <br /> ,a�.�«. s <br /> ��+�Moi.�e�va�e S <br /> H C�F-' <br /> � � � Print or Type Only n.�.,��.so�� S <br /> O�1b.' <br /> � y y __�LL- .e_�. 0 �„c� . 7v�' `!,. _ � t F'.r /' c � f7 u.f'z n/ '_ S '- �� 7 L <br /> y �, N Owncr Mailin�Atldross ' City Zin Phone <br /> K n <br /> H xl <br /> 'il M 47 �7-L✓�ic./ � <br /> yM AppliWnt MailinyAtldress City 21n Phone <br /> ��� Describe P�onosed Work — . � -1� ,� <br /> OH � <br /> H�g <br /> �]V � <br /> �� � Piolect Address(il I•.nown) - 7O .� �.i/��=�% � <br /> i..i O � <br /> n d y Atlach lour(A�copies ol plans br proposed work� Draw to scale and nole tae followinp as applica6le� � <br /> ��'� • Properly Lines • Cenlmlina ol sirect � <br /> • putline and dimensions ol all ezisliny and • Indicate No�lh <br /> �y proposed slmctures on Ihe lot • Show any proposed grading ch�nges <br /> y • Existing and proposed utililics • Show measuremenls <br /> � DO NOT Wf717E BELOW 71115 LIN[ � <br /> � PERMITCONDITIONS O <br /> � t.nll calls�or inspec�ion shall be made 24 hrs.in advnnce•n��ono 259•BA1 O. � <br /> � 2.All work shall be pedormed in accordance with Ihia permil t�nd wrrent Cily ol Everell Design and Constmction <br /> C� S�andards and Specilications. <br /> J.Call Location Undergmund Service 40 hrs.belorn you dig,TOLI FREE NUMBER 1•8C0•424•5555. � <br /> , I __ � O <br /> (/-(/-cK � JQ1�lArw� /�/�r� �4.'-f� . <br /> � G[lvtl�>s- � <br /> I <br /> ; I"1� �d � <br /> y -i,�-9/ � <br /> � __� a <br /> � ,_ ACKNOWLE�GEMENT OF CONDITIONS <br /> �,� The undcrsic�ned owner/applicant h;reby agrees Io holA and save harm� <br /> . less the City ol Evnretl Iroin � :•, and all claims lor damages, cosls, <br /> expenses, or causes o� :r un Oia1 may aiise because ol Instnllation <br /> and mainlenance of Ihe h �pwvemenl or other ri9hl•ol�way use he�eto <br /> ApnroveA lor Conslnmtion applied br nnd lurlher ag,ces to remove eame upon notice iwm Ihe <br /> Date Cily and lo replace public{roperty damaged Ihereby. <br /> PINAL INSPf_CIION pi�� <br /> ��Pn�oved�s Consirucled Signalure 01 AppliCarA Dnte <br /> PUBLICWORkSDEPARTMENT VJORK AUTHORI7[G 9V THIS PEqMIT MUST �E STARTED WITHIY <br /> 3Yo0CedarSireet 180 DAYS Of DA7E ,'ERtdl� IS ISSUED AND THFREAFiER IS TO <br /> �✓J [vemil,WA 98201 BE DILIGEIJTLV PUFS�SD TO :OMPLETION.THIS PERMIT MAV BE <br /> Phone:259�0810 CANCELLED BY TFIE CIT1 luVN ANY STOPPAGE OF WORK ON THIS <br /> Pf70JECT OVBR 90 DAYS DUP.:QION. <br />