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C <br /> Date " �3� <br /> v,�i�.� w��,.si•..,����i <br /> F� r�j"� <br /> APPhcation �or ein�i urm . �-1— _��L7-1�� - <br /> PUBLiC WORKS PERMIT ��-��;;;,;Fe`a� s -- <br /> ��*.�no� �en va�a S <br /> Print or Type Only A.��a"��n,�� s <br /> U����. ��2_I[�1�� Sl- Su 1 S� ��1� �� �� <br /> Owner eilmg Address City ip Hhone <br /> L�fvpac� �� �: � I D �Jr�.�rrir� � �� �i�.r�.� gg�n fc�l��-0� <br /> ApD��canl Mailing Address Cily Zip Phone <br /> Descrl6e Proposed Work � JI f-t��Cn�7 <br /> W <br /> P�o�ecf Addreas�if knownl � � <br /> Attech lour(4)copiee ol plens for proposed work� Drew to ecele and nole Ihe lollowing as eppllcable. � <br /> • ProDerty Llnea • Centarllne of street � <br /> • Outllne and dimensions of ell exlsling and • InAicete North <br /> propOsed structures on ihe lot • Show any proposed greding changes <br /> • Existing end proposed uNlities • Show measurem�nts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for Inapnctlon shall be med5 24 h�s. in edvence � phone 259•991 b. � <br /> ' 2. All work ehell bn pe�lormed in accordance with Ihis permll nnd current Clly ol Everell Design end Consiruction <br /> Standaida and Spncilicatlons. <br /> 3. Call Locetion UnderBround Service 48 hrs. belore you dig.TOLL FRtE NUMBER 1-800•424•5555. � <br /> y/3��/h�� O <br /> ,X/OT/��G,� . <br /> �� ,/ <br /> �-- <br /> i G� <br /> � 0 <br /> � <br /> ACKNOWLEDG[MEN7 OF CONDITIONS <br /> The undersiyned ownedapplicanl he�eby agree5 to holA and Save hArm� <br /> less ihe City ol Evnre�t irom any and all claims lor demages. costs, <br /> expenses, or causea ol aclion thel mey erise becnuse o� Instnllntion <br /> enA mainlenence ol Ihe improvemenl or olher riyhbof-wey use neretu <br /> epplied for antl furihe� egrees lo remove seme unan notire Irom the <br /> Approved lor Conslruction peta Cily and to replace public pioperty Aamaged iherehy <br /> FINAL INSPECTION Dale <br /> Approved es Conslructed Si9natiur. ol ApPlicant Date <br /> rverrtt PUBLIC WORKS DEPAFTMENT WORH AUTHORIZED BV THIS PERMIi MU�T BE SIARTED WITNIN <br /> � 3200 Cedar Street 1B0 DAYS OF DATG PERMIT IS ISSUED AND THEFEAFTEF IS TO <br /> Eve�etl. WA 98201 BE DILIGENTLY PURSUFD i0 COMPLEiION THIS PERMIT MAV BE <br /> Phone: 259�8815 CANCF_I.LFD BV TH[CITy UPON ANV STOPPAGE O�WORK ON TFIIS <br /> PRGJECT OVFR 90 DA�S OURATION <br />