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i . . .; <br /> #.,.�_ � .. <br /> k j <br /> i <br /> , . . <br /> ) �g � <br /> � <br /> ��� i . J � run�ic Wo-.�V�.mu• Z S�~ "_ <br /> � I� Data � �"� I ----- � --'-- <br /> p Applicalion For A�"0�"P� � - <br /> PUBLIC WORKS PEF�FJIIT P°°°°w������. s <br /> � ,�..�«. <br /> � � �z �y ,�,,.�o� ,.,P.,a � <br /> t� � i <br /> O��q Print or Type Cnly ' n,�„_�� u�e s 7 e � -- <br /> �tl �� <br /> W <br /> �� C� lnri S ��cc�k.S �7?, 11 p P�, SE, C.,.erctf 9YjZo8 3S3 -`IBqI <br /> O Owner Meilln�AAuress City Zip P�one <br /> p:� 54 �+t c Q s q(Jr w <br /> '�'�H Applicent Melling Atltlresa City 2Ip Phune <br /> � [ <br /> � Descrl6e Proposed Wo�k ���f+`��� L L/�IlC11� � ��C1��'�� Gq.�� <br /> �� __ — <br /> �� - W <br /> � PwlectAdd�ese�ifknown) �l3 �/C7 9�� S.E FW/`r� ._____ � <br /> Allach fow(4)copies of pinns lor proposnd work� Orew la scale end nole the lollowing es ap0liwhie� � <br /> • P�operty Linee • Cen�erline ol slreel � <br /> • Oulline antl tlimensione ol ell e.isting enA • Indicnte Norin <br /> p�opoa0d slructures on�t0 lot • ShOw eny proposed g+adinp changes <br /> • Exisling end propoeed utllities • Show meesuremnnls � <br /> si <br /> DO NOi WRIiE BELOW THIS LINE O <br /> I��, PERMIT CONDITIONS <br /> � 1.All cells lor Inspection ehell be mede 24 hra.in advence-phone 259-881 O. � <br /> , 2.All work shell be pndormed In eccordance wilh this Oermit antl current Chy of Evnrrlt Design 6nC Conslruction <br /> � Stendards and Specilicationa. <br /> 3.Call Locallon Unce�ground Servlce 4B�re.belore you Cip.TOLL FREE NUNBER 1•fi00-424��5555. � <br /> 1 �� <br /> I �� � p�� p� s �z ���r,-r� �., 5�.�-��:-J r�� ��r O <br /> I i''� /K S'�� � . � <br /> Y/ <br /> , �!_�� O <br /> � ,- <br /> � ��;�.u�C �/��/�� a <br /> -- <br /> ACKNOWLEDGEMENT OF CONUITIONS <br /> I <br /> Q� �!� �T � �i v�ol Tha undersigned ownnr/epplicanl hereby agrees to hold and save harm� <br /> I � lass Ihe Cdy oi Evernit Irom any and all clalms for dameges, costs. <br /> I � e•penses, or causes ol ac�ion Ihal may arise betau5e ol installetion <br /> � /�� Q n.� ���Q�� �� � �� end meintenence ol Ihe improvemenl or o�he� nghbo4way use harela <br /> �M~� applied lor xnd lunher egrees lo �emove same upon notice Irom the <br /> pD�oved lor Conslruction Date Gly end lo rr[lacr public property Oamaged �heieby, <br /> / J / �` <br /> L� Y ' _ r (� /��J� . n �+ <br /> INAL INSPECTION � Datz �/ ✓L`� !,�"� _ Z � � `'" <br /> pOroved ee Conalruclad Siqnetwe c�AOPlica Onte <br /> /,I� PUBLIC WORKS DEPAqTMENT WORK AUfHORIZED BV THIS PERMIT MUST BE SiARTEU WITHIN <br /> 7200CetlerSireat 180 DAV9 Of DATE FEN!dli IS ISSUEf) AIJD THGREAFTER IS TO <br /> Evarelt.WA 9B201 BE DII.IGENT�V PURSUED TO COMPLETION THIS PER�11T MAV BF <br /> Phone�.259�BB10 CANCf_LLED BV THE CITY UPON AN�STOPPAGF Of WOAK ON TNIS <br /> PROJE�.CT OVER 90 DAVS OURATION. <br /> � <br /> � <br /> ( � <br />