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Date Z-I - � I r��m,�w�,.,r.�mm. Q�-SF _ 'a <br /> APPlitalion For ���°� �°m . -__B��J�"�J�--_ . <br /> PUBUC 'VVORKS PERMIT �°,° W°,�°�°° ----- -- <br /> rm.ir.. S <br /> i ass non� �nn�e�n S A ; <br /> Na�anrr f+uv S c� �� I <br /> F'rint or Type On�y - I , <br /> _ v I �hST�'UCT/0 h No � .Th�. �ais'� ��S � �i�� �z�� G7/-9/S/� ' <br /> Owner Mailin�Address City Zip Phone <br /> I <br /> ��� <br /> Applicent Mailm�Atltlress City Lp Phone <br /> Destribe Proposrd WOrk 5������ S� S� . '�. <br /> ����o�h �Q'��t -- - — II <br /> ��:�� - - W I <br /> Frolect Address lil knowel ���Z r �0��� S� S� _ � i <br /> ��:'� Aflech four�4) r.opieS ol plans�or pronosed work- Draw to scale and nole�hr. lollowmg as apP�i�:a61<! � <br /> , • Property Li�ies • Centedine ol S�rerl � <br /> � • Outline nnd dime.nsions ol ell e.isting nnd • Indicate Norlh <br /> a�',. propused s�ruc�ure5 on the lot • Show any proposeA yiaAmy chnngt�s I <br /> • Ezisling and pruposed util�hes • Shoa measuremenis � <br /> � I <br /> DO NCT WRITE BELOW THIS LINE � ,I <br /> PERMIT CONDITIONS <br /> ` 1.All calls lor inspection shnll be made 24 hrs.in advance� phone 2S9•8B�O � I <br /> i��� 2.All work shall be peAurmed m eccordance wilh Ihi�permit end current Ciiy ol Everelt Desiyn and Consiruction i <br /> � Stande�ds end Specilicallons. <br /> ��-" 3.Call Localion Undergrountl Service 4A hrs.belore you Aiy.TOLL FREE NUMBER 1•800•424•5555. � <br /> �Il '.. :1'_� I I O III <br /> .. � '. I '_!.I_� 1. .'I�iii � . _. <br />?`'.:. ��.i� H <br />;�.� � � � , `�r.np_ ��!�IMyLiF�= MUEaT � ��� i � <br /> i �, . , r �,���� � � i i ���:i �-CTrIR. � <br /> �N �^,T �I_L , 7 ; O <br /> �: . , � <br /> ��^.r.nr- n-- r� � <br /> ACKNOWLEDGEM[N1 OF GONDITIONS <br /> �he unde�siynen ownr.dnpPL:ant hr.reby agrees to hold a�d SAve har�n <br /> Irss thu City ol Fvr,relt �rom nny and all claims lor Aamages, cne�,ts <br /> n e.pensoa o� causes ol xc�ion Ihat may nrise because ol mslallat�on <br /> ��� � ,y_ /Z ���p anA mamtenance ul Ihe improvement or olher nyhbul�wey usn heie4n <br /> Cl/C�T� ✓ ,i��li�� ���� ,�nd lur�hnr �qre�s In ramove snmr upon notiae Irom Ii�r <br /> ApProved lor Con511ZC�'on atP C;ily and to n�olai:e Piibhr. pmpeilY tlama9e.d �hriFUy <br /> � <br /> /� i j /' / <br /> i �.s <br /> ,` '� ,� � �� .2-/ � I�/J_ <br /> F NA' SPEC 10 . . ..bale __ . -1�----.- _ - <br /> /�PPn atl os Con9tiutled � S�9nntur . N ApPlic�nl Dab� <br /> WORK AUTI!ORIZED 8 THIS P[RMIT MUST BE STARTED WI�HIN <br /> rvrrrlt PUBIIGWORKSDEPARiMENT 1B0 DAYS OF fIATF PERMR IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CndaiStreal BE D�LIG[NTLV PVRSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 GANI:ELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> P�one 259�BB10 PROJECT OVFR 90 DAYS DURATION. <br /> � <br /> II� 1 <br />!�— I <br />