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Date = '�' � <br />PUBLIC <br />Print or Type Only <br />Owner <br />Appl <br />� <br />� <br />� <br />ApPlication Fc� <br />WORK� <br />0 <br />0 <br />r <br />i <br />r, <br />��/��p� � <br />�M,��iling A <br />PERMIT <br />�� <br />�� <br />P�e�i�c W� ne Vnrmn •_[J� ���G V_ <br />P�n9 Oe[I � ___ --'._--_— <br />r �,�,� W�,,. � �, s -- <br />Tm.i F.� .— . <br />...s �nn vc� r.��n S _ .—. <br />eai.,�,..we S .�C7�� <br />�,-�_�.,� -Yc �,�+�a-�,' ,43/ <br />Cd <br />�� cv�aT7 <br />es� N � C�ty 7�.� Phone <br />r- <br />��1�"�'}_✓c _ �-nn c��oSZ �°CaZL�'_c� � <br />Ma�lmq Adtlress City q� Phone <br />.i <br />Describe Proposed Work ��.ST�- _�"CLZ.�__ _�_'_�C��—�� CrY�S _%!� <br />�/Ii ufJ7c—l�Z�—LUC7� — _- _ ------ <br />i <br />��—� <br />Prola�� Addiess I�t knownl _ r� S�L� <br />Allach lou� 1�1 � oP�es o� plans lor proposed wo�k � Draw to scale nnd note Ihe lollowing as npplic:�Uk� <br />• Prcprrl�� Lmes <br />• Oulline and dimen5ions ol all e*isting anA <br />propused slrucfures on the lot <br />• Ezisting and proposed utdities <br />• Centerline ol Street <br />• Indir,a�e Norl�; <br />S Show any pioposRtl yr,�dinq chnnyr, <br />• Sho�t me.e;uremenis <br />WRITE BELOW ?HIS LWE <br />PERMIT CONDITIO�S <br />1. All calls for inspeclion shall be made 24 hrs m advance - phonc 2b9•88i 0. <br />2. All work ch311 be pedormetl in nccordance with Ihis permlt and tmrent City of Evrrr.!t Des¢7n nnrl CcnslrucUon <br />Standerds and Specficetions. <br />3. Cnll Location Underqround Service 4t3 hrs. brloie you dig TOLL FREE NUMBER 1•800•424•5555. <br />=��nE�"'�: ; = <br />�pp�ovod �or Conslruction Dato <br />FIN�NSP:CTI � r 7 ��� <br />�pproved as ConslructeA <br />rvr�rit PUBLIC WORKS DEPAqTMENT <br />� 3200 Cedar Slreel <br />Evt'rrlt. WA 9H:01 <br />Plinnc ; �y7 Flri1f1 <br />.1� hNOWLtnUCMLNI Of CONDI110N5 <br />ZI <br />O', <br />� <br />� <br />�� <br />O�� <br />a� <br />lhi� undrro�V���'d owner/aPPI�Ginl hereby a9rees to hold anJ s.i�c hurrm <br />less ihe Gly of Evmetl liom nny nnd all c:aims lor dnmayes, cosL•; <br />i�npenses, or causes ol aC�ion Iha� may anse because ol inslall�tio�� <br />and mainlenance ol �hc miprovrmen� oi olhcr nghpobway usr� herMn <br />nppl�ed loi and lu�lhrr nq�ors In romove same upon nohce trom Ih�� <br />CdY ���d'o irpl�ce puhh<. pr��prily demnQed thme6y <br />; / �--- :1y/' ' <br />s <br />_ �—_ ----- Date <br />4�RK AUTIIORI; [D THIS 'f RMIi MUST BE STARIED WITHIN <br />180 DA1�5 OF DATf. Ef�MI IS ISSUED PP D THEf7EAFTER IS Ti� <br />BE DtUGENiLV ?URSUED 70 GOMPLETIUN. THIS PERMIT MAY L7( <br />CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON TI-lin <br />PROJEC f OVER 90 DAYS DURATION <br />