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L�" � / �r' <br /> Oete �S � � �--' L� <br /> —� Puelm wod�Pumn� � <br /> Appllcetlon For Biaa osoi • _. <br /> PUBUC WORKS PCRMIT �°;�,a F,:`•• .�-:.-- <br /> len�p0�F��PUE � <br /> �u <br /> Print or 1'ype Only <br /> B�iannou� •r��lt9 ��� <br /> �l�C< �i�T�flG-�'1�lll' �,�1- ,1/�El�<<c--t��- - v��'Cl7 �!U-� l ��`/'/.5�� <br /> Owner Meilinp Addieea City Zip Phone <br /> � ',�S l�1/�lG�- ' �b�� �'1``� S I . C�. L-1/C�'L-1� ��J o�-�� �J �-���S �/ <br /> ApO��cent MeilingAdtlrese Clly 2ip Phone <br /> Deec�IbeProuosadWork _- C ' �L�!\ ���c(Si�W.✓ I(��i S � IL�UI�,Q�F(,' ��SC �J <br /> �C(�!I/n.)�— ��T[^ �r ti GT�i � '� �i�'IC7�f�ti-� C <br /> Pro�ect Addreae 111 kno�vn� �� r S ��� 74 S� [_ _ � <br /> Atlach four(4)coplen ol nlana for propoaed work• Drew to Scale end note Ihe IOLowing as applicable� � <br /> • Property Llnee • Ce�terline ol slreet � <br /> • Outline end dimanaions ol all existinp end • Indicate North <br /> proposed elructures�n tha lot • Show nny proposed giading changes <br /> • cxislinq and propoaed utililiea • Show measurements � <br /> DO NOT WRII E BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1. All calle lor inepection shell be maae 24 hrs. m edvance� phone 2S9•88�S � <br /> 2. All woik ehell be perlmmed in eccorAence with ihis permit entl current City ol Everelt Design and Construction <br /> Stent;arde end SpeG�icetlone. <br /> 3. Cell Locetion Undarground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. � <br /> � ` 7 _. " f,�.l.'�'<_,-l�-ti� /� f� ,' ?/" �`_'-�� `' /-1—.-r- ' <br /> i �r.�- . �/ ��. O <br /> t J /%/f' �L c=��'/NL� ��/n'/T S- N �"i2�c-' <br /> �, �;'� f_" i �i �< <' . , i 1 � <br /> ,�" .`>i�._���_) y�c I ` <br />� � .' ;, f�C !_ � �/�'._ � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby eBreea to hold and seve harm� <br /> _� less the Cdy ol Everelt Irom any end all clalms lor tlamages, costs, <br /> .. " - j __ . eapenses. o� causes ol actwn thet mey arise beceusa al instellation <br /> f;���;..' �� ����J^�,���yS� antl mamtenance ol Ihe improvement or olhar right-ol-wey use hereto <br /> AppryvE7f{or onstruction —r Dete apphed lor and lurthei og�ees to �emova seme upon nolice from Ihe <br /> ' / Ctly anA to replace public property damaged thereby. <br /> -7 r <br /> • C, ( � � t., : � 1� � <br /> FINAL INSPc TION Dela C� L � eL—.� (%C� '/ � ' �J S <br /> Approved ae Conalructed �S�gn9ture of A >Gcant Date <br /> everen PUBLIC WOfiHS DEPARTMENT WORK AUTH i71ZED 8V iHIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederSiraet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEFEAFTER �S t0 <br /> Everell. WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phona. 259�8815 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORi�ON THIS <br /> PROJEC7 OVER 90 DAVS DUR4TION. <br />