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�- <br /> Date��� I '. .,��,�,<<vo���r�„�m�. �I CoS-- <br /> Applica�ion Fo�'_? TO POSTI NG__�+��e��� �����; ���� �_ �,�/�-�-��--. <br /> P�JE�LIC W�RK�� PERMIT P°°��°K°��=F�° <br /> �]<7 H Totai Poe 5 — <br /> [xx7[riy� r�_"--'u �essapw Fee aam S <br /> a H �' o o c c� _ o 0 0 0 2G' � <br /> I rDXlx x= i;; .� c ::�. „ o 00o eri.,�«o��, 5 <br /> G r-+ Print or Type Only • • � • � • • <br /> 7>Hx C/� `v`� r- in c.� .r ,_� o 0 o c� <br /> H 9 3 � •r c� .:r :i. w t�.i .J r'. in t� <br /> .. 3 �n e. ur a, ea �J rO <br /> uy es '+ <br />' � y a C eG/1 P rrr� �rL'1!y-�-�-F,=-.��i—�y'B t=�c--�l�-,='�5`� - ��/ � -- <br />' O x O Owner Maiiiny Ac�,dres o' � r� x -�". 3 0�ci w :. i� Zip Phone <br />, � V1H r..i oo �i: c� m � o `- o -t [� w <br /> \ O _I J W [Y O ¢O W +-+ S <br />�' yx -yrg �'Lf P o a � a � w osc =x� ur ,-� c� —" <br />�i Cl1 C'!C+7 Applieanl Mailiny Adtlress City Zip Phone <br /> I� OH� � � f� <br /> �"� �� DescriGePron�sed Work _�f_� �L/--I-r.L-(1P-dLL—_� '� � �v — <br />` Y7� Cq] ! � <br /> r 9 H trJ — --- <br />� r z <br />' gHH W <br /> � <br /> H <br /> d�' »O 1 - Z�J-kh � SC � <br />� q C� Project Atldress(il knox�n� _ — ----- <br /> j 3 L�7 <br /> zy� A��;�ch toui i4)eopies of plans for proposeU v�ork Draw to sr.alF and nnte Ihe foilo:�me as.ipPLcel�i� e� <br />,� 1� O� f Property Lines t CenLrlme o�SI��.�ci ♦^ <br /> � Oulline and duriens�ons ol au c.�... . .,r��.l • ind¢;ate ^lcrlh V� <br />, PrOpOSed�irucWrE50n IhC IOt • �iOP:Ony proC�Sarl cl�:�ding Ch:inqe5 <br /> • Exlstiny and n�oposed unhbes • Shov: measuremem= � <br /> DO tJOT WRITE BELO�V THIS UNE � <br /> i PC-RId1T CONDITIONS <br /> �,0 1.;JI caus lor inspection shall be made 24 h�5.in aavance� phOne ZS9•$S�O �� <br />� � �! 2 All work shall be pedormed in acCortlance with ihis permit and cwren7 Gty ,i Evere�t Uesiyn ind Construction M. <br />�� ""`�+ Stantlaras and SpecilicaLons. <br /> II .Call localion Underqrountl Ser:ir.e 48 F.�;.bc�ore you diy.TOIL FREE �:�innoeFl 1-800•424•5555. � <br /> (.,. �., a 4_ TnAta] l rock �onstrur.t:ion ��nt;ranr.c� `�ehind driveway a� <br />, �� � per city st.ndard #20f1 to eliminaY.e tracking .nud onL-o O <br />' � �`� at;reotc� as di.rected by Publ .ic WorkA Lnapector_ <br />�; � \ 5_ P.eop r.iY.y �t:re�tr� clean at all times. <br /> i � 6. Cucb, gutt.er and aidewalk i.n t:he p.Lat ure new and L <br /> '^ � � � undan�3ged, any damage t:hereto ahal.l be replac��i et the r <br /> �� diecreti.on of che I'ublic Workn In�pector_ ♦/� <br /> � � ,� i_ Any change in Che di�iveway cui: must: �e approvec' Uy Lhe ��� <br /> � � J � Piihli.c Woc•k� ]n�pector_ Q <br />, B_ 7'i�ht:line alJ roof, yard and driveway drai.ne from <br />� `�� housca i:o C.I3_ �atuba at; back of fl1C�P walk witli rubbc�r � <br /> (� =� �� ga�keY. P. V. C_ pi.PP <br /> 9_ AajusY. water �OXP.D to grad� ah end of conatruction. � <br />� .� ]0_ Dc•iveways aha ll b�: complete7y cured before driving on <br />� � ! •� f}l�m. ACKNOINLEUG[IA[NT OP CONDI710N5 <br /> �'' /ll�(�;J / �� . �NSTf.�l �2MN �(ILG TO L�261N (.�KA.vLSUnC.C'. <br /> +� - lrJi TYa un�eisi9ned owner/npplican�herchy ngiees to hold and sav2 harm� <br /> i/: <br /> � -- -� i iess ihe Ci�y ol [veret� Irom any and ail claiins for damn9es cosls. <br /> � expenses. or causes of action �hat may arise because o� ins�all2�ion <br />� _, ("� i/�/1 _ ���, Z_ ��_� � and maintr,nanc� ol the unprovement or ather rig;ibof-way usc hcre�o <br />� _J�_���_� apphed for anA��t�ier agrce': to remove same upon notice Irom Ihe <br />, APProv U,for Constr�ction Dato Ci�Y���d��� �p l�i�hlir�r. �crty darna9ed thereUy. <br /> , / / " ,� .. /'.:� j j / / i ,i <br />� � �c.�1-C%����� f� �" � — / ( __' �q /��� " <br /> HNAL INSPECTlO7J � � ' �a:a -�-1 ��i " -- ~�`_-- — <br /> Approv�d as ConslructEd ignnlure of Applicznt Dair. <br />' Ii.�i.�iql PUBLICWORKSDEPARTMENT WORK AUTHORIZE' 3Y THIS PERM11 MUST BE STARTF.D WITIiIN <br /> II � 3200.:e.darStreet 180 DAYS OF DAIt P[RMIT IS ISSU[D AND THEREAFTER IS TO <br />� I�s Evcretl,WA 98201 O[ OILIGENTLY PURSU[D i O C^MPLETION. THIS P[RPAIT MAY �F <br /> 1`. CANC[LLED 6Y iliF CITY l PON ANY STOPPAaE OF\VORk ON THIS <br /> fhane:259�0810 f'ROJ�CT OVEH OU D,1Y5 DURATIQN. <br /> �:� <br />'V <br /> ti <br />