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� <br /> ' ,..�,� <br /> ���� _ p .-� <br /> � � � ` � r,�, <br /> Poeii<wo��.rem�n• <br /> y � Dfit0��90 eiaa o.o� •--W��-�— <br /> N Appllcation For <br /> ��� PuCucWOM�fe� <br /> PUBLIC WORKS PERMIT T��.���. '--- <br /> La�n�D01 feePeiE f.�—��- <br /> B+bnce0ue f�--- <br /> �� Print or Type Only <br /> ��-1� � � r � �-, n_, ���b iPiPM- /dL�_ q,P,h2 oTSa- PYa �, <br /> �Ti N L � C IY Lp <br /> �y Ownet Ma1Nng Address <br /> N <br /> W� <br /> � City Lp Phone <br /> �+ qppllcent Mailing Address <br /> O iA C� — <br /> Deetrlbe Proposetl Work <br /> W <br /> �l��y -�1r.��, ° �"' <br /> Prolect Addrees 111 known) � <br /> Attach lour(4)copiee of plane lor proposad wo�k-Draw to scalo and nole�Ceniterline ol s�Pee�ceble: � <br /> • Property Lines � Indicete North <br /> • Outllne end dimenslons ol ell ezisting and � Show e�y PrOposetl gredinp Ghen3es � <br /> , proposed etructuree on the lot � Show meesurements <br /> • Exleting end proDaeed utllilies <br /> , DO NOT WFITE BELOW THIS LINE O <br /> r•-�'��� • � PERMITCONDITIONS ' <br /> 1 t.All celle for Inspectlon ehell be made?!nra.in advance-phone 259•8810. <br /> � 2,pll work nhell be peAormed In au'o�dence with fhle permlt and current Clty of Everelt DesIB^end ConslmcUon <br /> Standerdn end Specillcatlons. � <br /> 3.Cell Loce�Ion Underpround Servlce 48 hra.before you diq.TOLL FREE NUMBER 1•800�424•5555. <br /> C� � . <br /> -�i3� i c �olz KS NCT (C�C',� O <br /> . �/�ZZ�X � <br /> , ��' � <br /> �c�c.��C..►�'1` k.`-'t- � <br /> � <br /> � -- a <br /> � <br /> __ <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> i licunt heieby agrees to hold end save�erm- <br /> The undersigned owner/apC <br /> � less Ihe Cdy ot Everetl from nny and all clairns lOr demages. cosls. <br /> e.Penses, or causes ol action that may ari�e because ol Instellation <br /> and maintenance ol Ihe Improvemenl or ot�er righPo4wey use hereto <br /> . applled lor and huther ag�ees lo remove saRe upon notice from the <br /> . Approved tor Construction <br /> Da�e C�IY and to rePlace pubhc p�operry damnBed V�eraby. <br /> Date — Dete <br /> FINAL INSPEC710N Signalwo ol APPlican <br /> ppprovedesConstructed yyORK AUTHORIZEb 9Y THIS VERMIT MUST BE STARTED WITHIN <br /> Oeverell PUBLIC WORKS DEPARTMENT BE DI�LIGENTLY�PURSUED TOICOMPLE�TION.DTH SEPERMIT MAY BC- <br /> 7200 Ceder Slree� <br /> Everelt.WA BB201 CANCELLEO BV THE CITV UPON ANY STOPPAGE OF WORK ON iH15 <br /> Phone:259�BB10 PFOJECT OVER 90 DAVS DURATION. <br />