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� �� ^. o��bl¢Worxs Pe�mil� �-�/ <br /> Date� 0RI9 Deot.s <br /> qpplication for �'� — <br /> ci <br /> !'�� Public Wo�ks Fee <br /> PUBLIC WORKS PERMIT �� 1otalFee $ <br /> �:. <br /> ���� Less AOVI.FPe Paia S_---�-- <br /> ' 6 � — <br /> , e:�����.,n�� S <br /> �� �.i �-. — <br /> `� ; ; �8�z� F�l <br /> Print or Type Only «- ;, , <br /> o.i <br /> i <br /> �DF �G-N��� P.� 1�8�0 7�.�2;`,`�L_F�i/YIU,U/J� GU/� � Z�s�k3 9s <br /> -��Y Z�p Phonc <br /> ' Owner MaiNng Ac'dress � =, ;,_; , , <br /> �..i �� <br /> � �: ._, fl � . <br /> !'� _ <br /> � �^ " - CitY Zip Phone <br /> . qpplicant Pdsilmq Address <br /> Descri6e Proposed Work �+s�-�-�-�3��� <br /> / <br /> ' Il�v_1(__���.ces�lt. _(AJG`�- r — � <br /> �G d� f�iu �Pvi �(��f--�-� ��` � <br /> Project Address(if knownl � <br /> � Attach four(4)coPies of plans lor proposed worK� Drav: to sr.ab,ann n�e�C���`erline o1 st ee�f able: � <br /> � • Property Lines • Indicate Narth <br /> • Outline and dimensions of all existing anA � chow any proposed yratlin9 changes <br /> ' proposed structures on ihe lot � Show meesu�ements M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BEI.OW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-881 O. <br /> 2.All work shall be performed in accordance wilh lhis permit and current City of Everetl Design and Construclion <br /> Stendards and Specifications. � <br /> 3.Ca�l Localian Underground Service 48 hrs.before you dio.TOLL FREE NUMBER 1•800•424•55 • <br /> �. �.�,,. �,r���� da �� �f -2a-9s � <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGGMENT OF CONDITIONS <br /> Thr undersigned owner/applicant hereUy agrees to hold and save harm� <br /> ------'—� less the Cdy of Everelt Irom any and all claims for damages. costs. <br /> � expenses. or causes ot ac�ion Ihat may arise because of installation <br /> �nd maintenance o! tne improvement or other righbof-way use hereto <br /> S �ppiir.d lor and luriher a�rees to remove same upon notice trom Ihe <br /> ale � Cd)•���h 10 replaCa Public propPrty damaged ihereby. <br /> Appro d siruct� I � <br /> /�, � � -�� <br /> � . . Date � Date <br /> FI AL IN PECTIO SignaWrr f ant <br /> ApprovedasConsiructed yypRK IiORIZED Y THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTPAENT �90 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Everet6 WA98201 CANCELLeU BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PRO.IECT OVFR 90 DAYS DURATION. <br /> I <br />