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i <br /> � <br /> I <br /> I <br /> ; <br /> � <br /> ,' <br /> ate=_ . . ' � r�e,ecwo,�.vn�mii. -- ------ -- <br /> ApPlication For n.+a nrM • <br /> 0 <br /> PUBLIC WORKS P�RMIT ������� °°��,�°° -----_ <br /> loini fee s— <br /> C iru�pn� FeePvc S <br /> 8 3 '�` <br /> r B•„��.o�� s �.';�`' <br /> Print or Type Only — <br /> � � i� <br /> N fJ <br /> .-� N N <br /> 1 <br /> �7Cr� o.vs r���.7.�,c� /'7�� l,��i.K.N�t. S�ir�.� 9Fj/.5'� 3�0.3� <br /> wner �4ail�no AdAress � -� ra � Cdy 7ip Phone <br /> .S ��—QLS1N z � K� ' �1�� - ---- — <br /> Applicen� Madiny Acidmss CiD� Zip Phone I <br /> DoscribeP�oposedWurk _1_rL�'/1p/Gl �/L��l��y'�_�/���y1.L=�IQE�tJ���jj� ___ . . <br /> �I��� S�iQ��F7 QyT�l�l-i.7-L�[..(�_2QP1..`12Z�%.�.v�lJ1J71-T—t1�_�ZKl_�4�$tLS�.. � <br /> Pro�ecl Address lil known� /L G7 Cr' �-� C��- ��l �- -� T- -<, - � <br /> � <br /> 4ttach lour 1�)copics ol plans lor Pro�nscd work � Draw to scalc and notn Ihe I��Ilowlnp as apPlicabh� � , <br /> • Properly Lines • Centerlme n� strcr�l �w <br /> • Outline nnd dimensions ol all e��sting anA • I; Ci�:ate North V � <br /> / <br /> proposetl sirurlures o�i�he lot • S�:w+nny proposetl yiadin�� changes <br /> • Eai5�ing end proposnr•Wilities 'Y Jhaw measurrmon(5 � <br /> DO N07 WI�ITE BEIf W THIS LWE <br /> PERMIT CONDITIONS O <br /> 1.All ca�is for inspection shall be mnde 24 hrs. in ndeance� �hone Zb9•88�0 � <br /> 2.All work shaP ba pedormed m nccordance wlth Ih�s permd and cwrent Gdy ol Everetl Desic�n anJ Construclion <br /> St�ndards end Specilicet�ons. <br /> 3.Call Location Undargroun�S._rvice 48 hrs.be�ora you dig.TOLL fREE NUMBER�•b�•424•$b5J. � � <br /> h/ -' - ' ' S <br /> //�i9//1�7�?.-%✓ .c;L �_t���'�,n� � ,"�/1J7�c••C i; ' � <br /> —,� � c <br /> "-:�; - �r ' %<� �` �J � -`. . L� �� <br /> ♦rA , <br /> V� <br /> � <br /> � <br /> ,�� <br /> ,v v:raowu_u���r.�� rvi or curioniuNs <br /> Ih�•un�b�",,inr��t owner/apphcnnl hereby ngr@ns lo hold antl save h:un <br /> �----"---�-- -- � ----. . . . _. i�•s� u��• Cny r.i [�eien Irom 2ny and all clalms lor damxyes. cos�s. <br /> _. .� � --- �-_�j "�,� � _ e.penses or cuuses ot nction tnat may arlse becnuse o� installat�rn <br /> ' - , `,S- �/ �� anA mainlen�nce ol Ihe miprove�nenl or olher nght�nbway use he�eln <br /> __.yyyqqq - � •� applu+A lor nncl lurthrr a�,��ecs lo remove Same upon nohr,c Irom Il�e <br /> ApP�nv lor Consir r.lion , '� Uate CdY���d •„ rePlac�,pubhr Proper�y dama9ed �he,�•t�y <br /> O /��S <br /> 1 / '� -�—�- �� "-y _ �� � ��yj/��2 <br /> F tl 8P IUN Date - L�/ � _ <br /> Ap;�roved es Constructed '9r ure o Applicant � Dalc <br /> � l' RK �UiHOi712[D BY THIS PERMIT MUST BE STA��TED WIIHIN <br /> �rctt PUBLICWORKSDEPAFTMtWT ��� DAYS OF DATF PERMIT IS ISSUED AN� TH[REAFT[R IS TO <br /> � 3�00 Cedai Street pE piLiG[NTLY PURSUED TO COMPLE710N.,iN15 PERMIT MAV pf <br /> Everel�.W/�98201 ChNCf I L [D BV THE CITY UPON ANV STpPPAG[ OI"W017K tlN THi; <br /> Plionn ?Fd-BP10 pq,l,�[�:1 11Vff� PO f1AVS f1URAlIC1P1 <br />