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i <br /> Date�"I`i-�7� '�''�r� �- <br /> n�per wa„s r« <br /> ApplicFdion For Bi o�n� 1�L-�' (L�-- <br /> P BLIC WORKS PERMIT ���`'���--- - <br /> U r�n���wo,w.ree _ _ <br /> tnini rnr S_ <br /> I.tis Am+i �r•ve�n S--��— <br /> Ba�anrrpor s ?� [/V <br /> Fnnt or Type Only <br /> �14A1.-��� 17� 71 l�!� lr�l�j� � ' �1L'I'1� �°� --�/kl ' <br /> Owner Mai�'ng AdAress City Zip Phone <br /> � __r�/1 Lvip _ <br /> LL'�1J1_— -- — <br /> Appliwn: Mailing Address City Zip PhonC <br /> Descnbe Proposed Work � "��_���— � �� L ARSo�✓ PL�GE _ <br /> Prolecl Address(il knownl ��� — �,Q ��/ `•�'-E — — � <br /> � <br /> Attech lour(4) copies of plans for proposed work� Draw lo scalc and nole the lollo�.viny as apPlicable. � <br /> • Proper�y Lines • Cen�erline ol S�reel � <br /> • Cutline nnd dimensions ol all e.ishny anA • Indicn�e Id^rih <br /> prOposed Siructures on IhOlol • ShOw any proposed c,�rnAinq chanyes <br /> • Ezisling antl propused ulilities • Show measuremenl5 � <br /> � <br /> DO NOT WRITE BELOW THIS �iN[ O <br /> PERMIT CONDITIONS <br /> 1.All cnlls lor Inspeclion shail be made 24 hrs.in advence� phona 2b9•@810. � <br /> 2.All work shell be pedormeJ m eccordnnce wllh ihis permit and cunent Qty ol Everett Gesign and Construr.tion <br /> StanderAs aod Specilicnlions � <br /> 3.Coll Locetioi Under7round Service 4B hrs belo�r,you di9 TOLL FREE NUMBER 7•800•424•5555. � <br /> � <br /> !��; . � 4 I � �. . . � :. � . , . . . . i i. .- � <br /> 5. USE FUE�L IC ahA 1 rdAt�E SYS i h_Ih {d5 F'f20' � <br /> 6. ANY L07 (3RA1)E CHFdhIUES 11U5T PE F1Fhi � <br /> FUL�I.IC WUkk-S iIvGPF_CTCIf�, <br /> ?. I'.F.�P �T"IV STREEiS CLErjN � <br /> +' Ini4TALI_ WATF'F EnXr'� '�f7 <br /> W <br /> AChNOWL L DGLMCNT UF GONDIilONS <br /> 1 h��und�,is�,��•ud ow.tCVnPPIiCan�he�r6y anree5lo hnld dn�t„ici�hnrnr <br /> -- ��--- b•,s vu C.dy ot Evernit Irom any anA all claims for dnm,iq�,n. ,�nsl� <br /> e.punsCs. o� c�uses ol action that may anse ber,ause cl insldilCo m <br /> i- � � Bnd mTinlenAnce OI ihe improvP.ment or olh@r npht-obW;�y u�,e� h.�n���-� <br /> � �'-�� L � h-B qpplied Im end IuCher agrees lo rpmOve same �pon notn�.c �����n �n,� <br /> Ar�Proved Constru t n ale C�IY 2nA I replacn P��bh PCrIY�1�ma9ed iheieby <br /> , � • r � <br /> � i �4 <br /> �= ' ,�l_ � � i �s, l =--��, - < <br /> FINA INSPECTION �- " Date - �'.-�� `� <br /> Approved ns Consiructed na �re af �. i �����" <br /> i <br /> rvrmll PUBUCWOFKSDEPARTMEN7 WUfiK H E� BY THI P MIi MUST BE 57ARTED WIIInN <br /> 180 D S F DATE PERMI ISSUED AND TIIEFEAFTEH I; I�-r <br /> � 3200Cod�rStreet BE DI IG� TLY PUR;UFD TO COMPLETION TFiIS FERMIT MAv I�f <br /> Everell,WA 9B201 CANC - . FD �V 7FIE CITv UPnN ANV STOPPAGE OF WORk ON 'i�i'� <br /> Phonc 259�BH10 pqp,�[Ci nVf_N 90 OAVS OU!�PTION <br />