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i <br /> � <br /> Date����-"�S �„�,.,� v,�,�,�•..,m,�. 6� <br /> ".PPIicAtwn For fl'� ��� •� �L��'I� ���. . <br /> PU B LI C WO R KS P E IR"A I T °„°;;,��??'�_����� <br /> ��,,.��,� �.r��,,, s <br /> n.�,,��.o,�. S ��� <br /> Print or Type Only <br /> � <br /> ����v �"��� I �J� 1�7�� �.t. #�� ��r��yt� g85-�IX� <br /> Owner MNiling Addiess Gly Zip Phone <br /> __s..l.'lll--LL► <br /> � Applicanl Maihnq Address Ctly Zip Phonc <br /> Describe Proposed Work � c,lf�(J1� ( L_�Y����� ��, <br /> _— -- W I <br /> Prolec�Address Id known) �'"�� — ��Q� ! �• 'SE _ � I <br /> Attach lour(4)copies ol pILnS for proposod work� Drnw to se.�le anA note Ihe lollOwing es applicable� � <br /> • Pronerty Lines • Cenlerline ol slreel � <br /> • Oulhne and dimrnsio�s ol all eaisting anc • InAicate Norlh <br /> proposetl structure5 On�he lot • Show any proposed�mAmy chan9rs <br /> • EzisOng ond proposed ulihlies • Show me.asuremenis � <br /> DO NO7 WHITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for Inspection shell be made 24 hrs.in advance- phone 259•88��. � <br /> 2.All wnrk shell 6e peAormed in nccordance with�his permit and current Gry ol Everotl Design and Conslruction <br /> Standards end Specilicatlons. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FRCE NUMDER 1•800•424•5555. � <br /> 1�c � in 1 �� ;; , j .��.� '_. i ,� ;. ,. �_ , . .i, � � . <br /> :, USL: �UL+L1C UFAT.I�I��tUL_ . Y�TtM AG FRO'J1' <br /> ANV LOT GftADE? CI;AI�IGt:: IHUSl HL-' AF'f�fiC' � <br /> I�UEIL.TC WO��f:S I14�;F�:1;1"OF`. <br /> . YEE"P C1 TY S"fiiE.i�f S CLI�l�Id F,i� r-��.L T 1 hIE � //� <br /> Ih9'•TAI. I blq-rr-f� `''flyc�c '�(i !-.PiAI'i (;T 'f'Ilf V� <br /> � <br /> � <br /> AGNN(�Wl C.UGFhdI-NTl1f CONDIIIONS <br /> ihi�unde�s�q��ed ownm=�ppLcant huir�Uy��yees to holA.�nd sa�r hnrni� <br /> — i��ss the GIY ol Everetl Irom any and nll claims lor damn4lFs. rost�. <br /> —// / �uprmses. or cuuses o� nction that mey anse bzcause ol mst:diai�„n <br /> �_J� '���� � /-� ✓7 ��/n� anA Rl�llI�C�AIICP OI �hf m�p�ovemxnl or olhe� nghbol�wny use h��n�i,� <br /> ��[ Da�=7 L LI qppfied lor nnd IwtM1er 1grr.es to remove samr u0on noh�.e� Ir�.��„ ���,� <br /> APn�oved onstructlop � � Dale � ��o �Pp��cP �r properly clema�ed Ihe.iet,y <br /> �—C..O � � ���� � � � �� ` <br /> / _ � <br /> FINAL INSPECtION� � Date � � ��' � ,�>.�.—_�/=��.r� � . <br /> Approved as Constructed Si nalur �plicant D:�'� <br /> vvrn•11 PUBLIC !'ORKSDEPARTMEN7 WOR AUT 10RIZ[fl B 1 IIS PFRMIT b�UaT BE S7ARTED WIII� �. <br /> � J200Cc.arSlree� 1B0 DAV OF DATIi F�'_ IT IS ISSUED AND THFREAFT[k c, ' � <br /> Evcretl,WA9B201 BE I ENTL'( PUR$UE� TO COMPLETION THIS PERMIT Mhv i�� <br /> Phanr 259�BA10 CAM1;;EL LED BV THE CI7V UPON AN'/STOPPAGE OF WORK ON 7 i'. <br /> PROJ[':T OVER 90 UA`�5 DU(7ATION <br />