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Defe�7 n�.� < wo,w,v�,��i. c�b�SC� <br /> ADnlic��nn F�n �r�v oeni ._���.au�___ <br /> PUBLIC VYf)R6�� F�ERMIT ����°°W°,�.,•° <br /> .o�.���� a <br /> �o.s�nn� ve�r::ia S <br /> 7 ��_ <br /> n., P rn�� S .—O <br /> Print cr Type Only — <br /> I�EI�] a-Srf,� �ti .'_'�,.�rz�i� Lo�a Si���rns , //,� Y�ZS,P G�s .�-�U�S <br /> Owner rviniling Addros� Ci�y Zip ('lone <br /> �iM L _ ' __ <br /> Appllcanl Me�hngPtld�ues Ciry 2ip Phone <br /> '1 " � '��' � " <br /> Deecrlbe Proposad Work P�.1 S�[�.Cl— �_T(�f�(!.,_�. ���. ___ <br /> y�� -- � <br /> +� , � � <br /> Profect Addreas pl knownl �I.i �"���G �� �rC — <br /> Altach lour(4)coUies of plana lor proposed work- Drnw lo scele end nole th�lollowi.�g es epplicahlc: � � <br /> • Properry Llnes • Ceolerllne ol slreet � <br /> i Jutline end dimensiona ol ell eaislica end • Indicete North <br /> propoeed structures on the lot • Show sny propased grnding changes <br /> • E�Isling end p�oposed utilitlea • Show measuremenis � <br /> DO NOT WAITE BELOW THIS LINE O <br /> F'ERMIT CONOITIONS <br /> 1. All calle lor Inapecllon shall be made 24 hra. In advaneR• phone 259•881 5. � <br /> 2. All work shell 6e perlo�metl in acco�de�ace with this permit antl current City o�Evereit Design nnd Conslruction <br /> Slenderds and Speciil�ations. <br /> 3. Cell Location Untlerground Servlce 4d hra. before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br />' O`•. . .,t. i �UGL.II. URH1Wq;,,�_ CrS�'�PI � <br /> : .ANt LCJT GV?AUE CJ'AWGF�' MUET BE AFF�.' i' � <br /> PU6i_IL, lJOkk:, iI�ISFECfOR. � <br /> 7. P:E.FP C:LTY S1RC�:TS CI..EAN AT AL.I_ TIh11=' Q <br />� B. iNSIf!LL Nl�� rrr� i � r:� �, r, � . ,. , �.,�� � <br /> s <br />� o rq��, i': �.II.�,F �� <br /> ACI(�JOWLEDGEMENT OF CONDI�IONS <br /> ihe undersigned ownei/apPlicanl hereby egrees to hold and seve harm <br />�"�'-' —� — Ir�s the City ol Evriett ircm eny nnd nll r.leims lor dameyes. r.osts, <br /> /^ oenses. oi ceuse: of aclion thal mny erise beceuse ol Instellnilon <br /> �-.-74'i;���� i u �d maln�enancr. o11he improvement or othr,r nqhPof�way use hnreto <br /> �t �v� ap•'.lied lor end lurthm agrees to remove same upon notice Irom Ih� <br /> Approvetl lor nst lion ale �j�y�nd to replAce publlc property demaged ihereby. <br /> � � • tr,-.P9 � �1 LX <br /> FINAL IN. ECTI Dele � _____�e��,%/ ��L_�s,�. �'.ti��� '7-." - <br /> Approved es Construct�etl��� I Si{�neture o Applicant � �Date <br /> rverett PUBL�C�VORKS DEPARTMENT WJRK AU7HORIZED BY THIS PERMIT MUST BE STARiED WITHIN <br /> � 3200 Crc�r Street 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFiEP IS TO <br /> Evriett.bVA 98201 P[ DILIGEMTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Phonr�. 2'+° 8015 CANCELLF' lV THE CITV UPON ANV STOPPAG[OF WORK ON THIS <br /> ' PROJECi O�cfi 90 DAVS DURATION. <br />