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i <br /> � <br /> � <br /> � <br /> � <br /> � <br /> ;�-:3���n ���a-.�s <br /> Date_—s. �.�� v.,,.,�•,.,�, . i Q/' � <br /> APP6cahon Por • i��ao u«e�� . _ya'�l-1�[]_LJ_-_ <br /> PUBLIC WORKS PERIIAIT , !�„�`,n?'� _19_�3__— <br /> Itoi,ir.� � S '_ <br /> i ��s�en�,i r.e�nn S ^ <br /> Ba�ance Durt S�l/O_a- <br /> Print or Type Only — <br /> _[��t��rY�I� I�f�� �U . .�-!H� ���7 ?"N 1TLc�(�L_n '� -`-�7-S�'ll� <br /> Owner Mailing Address Ciry Zip Phone <br /> —._"���SC.. —__'—_ ____.— — <br /> App�icant Maihng Addrcrss Cdy Zq'� Phonp � <br /> Describe Pmposed Work _La,���y_�-�_J���;��. __��_f�3 �C.���_2 �� 111,'1 ��'[��� ', <br /> s-.�i_ A --- _ - W <br /> Project AdAiesa(il knownl ��9 � /�l. -s� _ _ � <br /> Attach low 141 copies of plans lor proposed work- Draw lo sr.ale�nd note the lollowing ns apphcahle� �� ' <br /> • PrOpelly LIlIeS • C.en�efllnB OI SIrCCI `A <br /> • Oulline and dimenslons of a�l eristiny anA • Indicate Norih v� <br /> prnposed siructures on ihe lot • Show nny proposrA yrarLny c!r.uiyvs <br /> • Existing nnd proposed utilities O Show measuremerts � <br /> DO NOT 1NRITE BELOW THIS LIN[ <br /> PERA4IT CONDITIONS � <br /> 1.All calls�o�inspe�:tioa shall be made 24 hrs.in advance�phone 25J•88�0. � <br /> 2 All work shnll be pedo��ned in accc,dance with Ihis po�mit and current Cily ol Evr,relt Desiyn nnA C�nstru�tion <br /> Stendards end Specltcatians. <br /> 3.Call Location Underground Service 4B hrs.belore you dig.TOIL FREE NUMBER 7•80�•424•5555. � <br /> y ,�,Ty s,,1�sT 9.�E Tn �..- ffE�7 CIGAn/ 9, �« �,M�-S � <br /> •S USE ��dc.0 .r�.c'A%�/�5.f c$f/,�7'6/n �iE' iPc+�If• R'�� lbc�W-f'F2� <br /> C'O�V�/�tr.�,t/S. � <br /> (. .5;.�6:��t.f .9/iv .�,�'.v�zri9y .9,e� N6c✓ ,� v�cy.c�re,�/� A.v�/ V♦ <br /> ,�,Am9l.,� i0 7H��✓I .S'Nf✓;.L dE if'F.�jiFF�,�;��'�yc£U df/ .9i�l�l��/T O <br /> 7. 9�vy/ C//q•c�GE �.�; 1�.E'�c��C��qy/ Lvc�l��n.�l rr�C%rr ,a� A/�i'.>ovFD � <br /> J�2i0.�' Tn J�S.—ACCA7i0A/, <br /> ACKNOWL[�GEMENT OP CONDITIONS <br /> Thp untle�signeA owneVapUlicant hereby ng�ees to hold and save h:�����- <br /> — " lesc thr Gly ol Everell hom any and all claims Inr dameges. ru•.i�. <br /> ,/ p�pen5es. or causes ol ;tclion Ihat may anse because ol insialL�h��n <br /> ��Rk�'�I' / �9 / ,' /� nnd meinlenence nl �he imP'ovemenl or o�her n9h1��I�weY usf� hr�.qr. <br /> /��- /f��'�— �J� appheA for anA luither agrees lo remove same �pon no�ice Iwm n��• <br /> ApProved lor Constiuct n � ate CitY�nd �n :eplace V��bhc properly damayf!d the.f by <br /> /�/% '.c� ��i� /� <br /> � l = 7,' iC _ � , ( ��K/ <br /> fINAL NSPECTIO ' �� Dalc "`�--`� � � � � <br /> Approve.d a� Conslructed Signature ul APn����nl Deir <br /> e•errrtl FUBLICWORKSDEPl�RTMENT WOPK AUTHORIZ[D BY THIS PEFMIT MUST BE STARTED WIt1�R•I <br /> � 32ooCeAarSlreel 1B0 DAVS OF OATE PERMIT IS ISSUED AND THEREAI"TEFi I'; 7��� <br /> Fvnreu.WA 7e701 BE DILIGENTLV PUP�UCD 10 COMPLETION TNIS PERMIT Mnti� I�I <br /> Flhnn�� 759-oF,lO CANCELLED BV THE GTV UPON ANY STOPPAGE OF WORK ON 11 ii�, <br /> PROJFCT OVER 90 DAVS DURATION <br />