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oai� ��'���3 <br />�pplicalion Por <br />PUBLIC WORK� <br />Print or Type Only <br />Aovden Rr <br />ownar <br />I��I��I�� �� g3'3�� <br />�^ ` ��I PueOr W+rws f .rmrl � � -- <br />� l_I g�Ep �ew • . �3� <br />C:_.:1�- iS`i3 — <br />P E R M.I T _ P�e�,�. �.... , zo ��� <br />To��� Fee s ---�— � ' <br />� — CVL RCT I........ Lms Aoo� Poe a.�a 4---- � � — <br />UTY Or � s��2,o•r�— <br />��� � : \P';r'✓,� fl,q'� BaanreCue <br />����� <br />;y <br />t �8201 <br />Inc., dba J 6 D Builders, 14;,9 Broadw.�Y, �verett98201 <br />Boyden Realty, _— - ���y Zi� <br />qppllrant Moifnp ACdreea <br />Deacrihe Prapoaed Work Sin le Famil Residence ._ <br />a <br />m <br />252-1166 <br />Phone <br />-- gtnce S E- Ev�.--� Washine,ton - Prc.___— — <br />Project Addresa (11 knownl —��� <br />s .�•—r <br />Attnch four (4) copies ol plens lor propoar.d work � Diaw to ecale and notn � Ce�,�e�ine ol stpeei; able� <br />• Property lines • Indicate Norih <br />• OutUaa end '^�cns cns ol ol� e.�sl��',y �nA • Show nny proPosed 9r�dinq ch�nyes <br />p�ppoy,A fhucW�ei� o� �he �o� � Show measuremenls <br />• Exleting antl propos�:d ulillties <br />PERMIT CONDITIONS <br />t. All cells lor inspec�ion shaii be made 24 hrs. in advance� � nhone 259•887 5 <br />2. All work Shxll be perio�^�ed In nr.cordance wilh Ihis permit and cunent Ciry u� Evt`i�`II Desipn and Cnnsliucuun <br />StnnC��ds nnd S�.�ecilicnlions <br />3. C�+�I Locniion Un; ere7�ound Service AFl his Le�o�e you di9 TOLL FREE NUMBER i•BOO•424•555 . <br />% ' [t � <br />Date <br />{,pprov�:d loi on91r c�iw� <br />���, n!'( 1. C J-1 �"��i �� <br />�—Oate <br />RNAL INSPECTION <br />qppioveh �s Canslructed � <br />� ��1 PUBLIC WORMS DEPARTMENT <br />I �,i200 Ci�dnr Stree� <br />C.:rre�l WA 90201 <br />�,��.�ntc :59-R815 <br />� <br />O <br />;,�,r yf�:! � I'-GCMCNT OF CONDITIONS <br />i P��• undei5iyoi�J '�".� i' ....�. ���' hr��ObY •'4ree5 �o holA nnd 58ve herm- <br />io�s Ihe Cny ol E+men Irum �ny and ell clalms for demep � costs. <br />e,penses. or r.auses of action thnt mey erise 6acause ol h .:lation <br />anA melntenanr,e of Ihe m��provement or other riqhbobwey use hereto <br />ypplmd lor and lurther agrees �o remove sarrc upon notfce Irom Ihe <br />Cily anA to replace public properry dnmaged Ihereby <br />S //�e.+.�1 i /�S f <br />�� Date <br />ignature O� ApPhCnnt <br />WORDK YSTOFRDATE� PERMIT ISEISSUED ANTD`'TNERE FT�ER ISHTO <br />E3F OII IGFNTLV PURSl1v�Uf0 CONP ST��rnG[IOF E ORh (�N Tr�L <br />..rl�l i i ff� B'%TI�1 <br />�I�i.; ��. t.l i�,:I I. iJ UqV�, fiURr.tIr1G <br />� <br />t: <br />