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� .:, £ <br /> �+ <br /> , � <br /> ;� � . 0 <br /> A�� �► � � <br /> C �J v�ee�wo,w.v.,mu. _ — <br /> ��� oele� l� 9/�27�.Sn — <br /> Biap oao�.�_r7__ <br /> F� Applicatlon For <br /> PUBLIC WORKS PERMIT P�O�icWorw�F�s � <br /> ��� To1�llee <br /> le�NpDl(OP�q � <br /> �y� <br /> Babnca0ua S <br /> p Print or 7ype Only <br /> N <br /> �� ,P loh �l�l�ehrand 9; o�Ji�:)r Ev�ret/ 9�2Q3 .�=33�� <br /> � CItY Zip Pl�one <br /> �H � Cwner INalling Address <br /> H <br /> �M ApPlicant Malling Address � CItY ZIP Phone <br /> ��A ` <br /> � �,�� � r�' acl'dr, a s%R <br /> y Deecrihe Proposed Work �� <br /> O <br /> - — W <br /> Prolect Address III knowrr � " � / � r H <br /> � <br /> Altach lour(4)copiea ol p:ens loi proposed work• Draw ta scale end nota Ihe folb�virp ae nppllcahle: � <br /> • Property Llnea •Cente•Ilce ol street <br /> • Outllne end dimenaionn of nll eaiallnp end • Indicat e �Jorth <br /> prnposec�structures on the lot • SM1ow iny prop��sed grading chenges <br /> • EKleting•md�ropoaed utilitles • Show meaaure�aenis M <br /> W <br /> � [O NOT IVRITE BELOW TMIS L INE O <br /> �?'+�� PERMIT C�NDITIONS � <br /> � 1.All calle'or Inspactlon ahell be mt�de 24 hro.In edvence•phone 259•8810. <br /> � 2,All work ehell be peAormed In eccordence wilh thla permlt end current Clty ol Evtirelt Desipn end Construction <br /> � Stenderde end Speclficalions. � <br /> 3.Cell Locetion Underground Service 48 hre.belore you dig.TOLL FREE NUMBE R 1•800�4245555. <br /> �� / �, r � 7 O <br /> C� �f r/1L'�e. !t/rn�- �^_��.*7��:��c��Ccti�tr c� <br /> ; , � <br /> '�z >� <br /> ` ��� [ -/y -7/ N <br /> � <br /> i __ a <br /> , I�I �I� � qCKNOWL[DGEMENT OF CONDITIONS <br /> I i The undersigned owner/epplicent hereby ag�aes to hold end save harm� <br /> less Ihe City of Everolt Irom any and ell cleims lor dameges. coats. <br /> � ezpenses. or causes of action that mey arise heceuee of installation <br /> __ end maintenence ol Ihe improvemenl or other riqhl�ol•wey use hereto <br /> epplied Im and lurlher agrees �o �emove snme upo� notice irom �he <br /> - ApOroved lor Constructlon Oale City and to replace publlc properly dameBed thereby. <br /> FINAL INSPECTION DP�O Da�e <br /> Approvod as Consimcted Signature ol Appficant <br /> WOPK AUTHORIZED BV THIS PERMIT MUST BL :fiARTED WITHIN <br /> � PUBLICWORKSUEPARTMENT 180 DAVS OF OATE PEPMIi IS ISSU[D AND ThIEREAFTER IS TO <br /> 3200Ceder Street BE DILIGENiLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4 WA 98201 CANCELLE�BY THE CITV UPON ANV STOPPAGE OF WORK ON TIiIS <br /> P�one:259�BB10 PROJECT OVER 90 DAYS DURATION, <br />