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Date � �� � <br />Applicalion Fui <br />PUBIIC iNORKS <br />Print or Type G dy <br />� <br />.� �l < < ' . <br />� � �:, �-� � n� i <br />�i�j��'i�[�u��l�� <br />PERMIT � �,� 1�. �sbs <br />_._. . ._ . . ......... <br />cirv or �v�R�rr <br />, � ,,, <br />. /��.,, . ,... , . '. <br />� � <br />� �.. �;:.� �-, , i.'. � . _ ) ...� :7 ����o.-.�� 1 <br />i. �.� <br />� Applicen� " - � , , • Mallinp Address / C�ily <br />�(%� ,.. I ! ' �9.... . . .. , ' <br />,i <br />Descrlbe Proposed Work �7.'�+� � � �� �' •v "= <br />n„o� � w.,�u re„�e '-��� q �U 3 <br />�Binp 000� � �ffLl�— <br />PuEi¢ WorM� Fae a�_� L� � <br />ialslfee <br />lees �OVI Fae P40 f�]A - <br />�Bebnce0re t�`�' dU <br />- ,�_:��-- � -r-- - <br />Pro�act 4ddress pl known� � �. —.�.s"-.,-- � � ��= --- <br />af sr. /(,r <br />Atleeh four (4) copies ol plens lor proposed work - Draw lo scale m�d nole ine hJtowing es applicablc <br />• Froperty Lines •(:� ��.ern�iA pi e� e�t <br />• Outline end dimensions ol oll existing end �. in ��.�Ie North <br />proposotl st�ur,�ures on tl�e lo� • W��uw any proGosed graA�nci ch++n9es <br />• Evisting unA proposed utililies • Show measuremenl5 <br />:y�l <br />. ' " i <br />_ _"'b.Jt ' <br />P�una <br />PERMIT CONDIilONS <br />1, All cells for InSpection shnll be mede 24 hrs In edvance � phone 259-881 5 <br />2. All work shnll ba Oerlormed in nceordence w!ih this permit nnd current City ol I:�e��•n Des�yn and Constnir.uon <br />StenAards Bnd Specilicetions. <br />1 Call Lor.alion UnAer��round Servi<.r 4Fl his linlnro you diq TOI.L FREE NUM�EN 1•800•4'14•rJ5rJ�J. <br />i <br />APProved <br />i ! �C� <br />� Do)e <br />r" <br />FIP;AL INSPEGTION \ <br />�nuroved as Conslr�cted \ <br />/ <br />i•���.��.�� PUBLIC WORKS 0 <br />� �200 Cedar Slreel <br />Fvrrn�L WA 9/3;!01 <br />PII n�� : S'.i 7iB1', <br />W <br />� <br />N <br />� <br />� <br />O <br />a <br />nckuo���i.tocErnrrirur coHoirtoHs <br />?he• undeisiqnod mon��r!aFUl�r.nni heirLy agree5 �O hOld end 80ve he�m- <br />less Ihe City ol Eve�ett hom any and all cleims lor demapa6, cusis. <br />e.penses, or ceuses ol action Ihat moy anse beceuse ol Instellalion <br />nnd mainlenanr.e ol Ihe improvement or other right�ot�wxy use herato <br />app11=U'r.� antl }urther agrees lo remove same upon notico Irnm Ihe <br />�qY u� o!. reylaae P��GGc p�aPertY dan.uyeA ihe�ehY <br />�/i. _ _� �— �� ��/S/�� <br />Signelure ol Applicant Date <br />WOFK AUTHORIZED BV THIS PERMIf MUST BE STARTED WITNIf: <br />100 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEii IS Tn <br />BC D!LIGENiLV PURSUE� TO COMPL[TION. THIS PFRMIT MAV �L <br />l.. l�t�l I I f� B�' 1HE r:ITV UPnN �NV STOPPA�if OF WORN O'J TM,`i <br />1'1 I Jl.l�i i-�:� �. '�)I��:lh I�UFAIIi)N <br />