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� �,,. �'1 � y' -S <br /> � De1e-3j�T ` I PuOueWorh�Perm11• �(0��7L <br /> Appllcatlon For aiao.o.o�_.��(,_Q�_Z,� <br /> PUBLIC WORKS PERMIT �°;o,:Fs•Fe� � - <br /> , �u..eoa�r.e v.m f <br /> Print or Type Only B�i�ncs Oua • 2�— <br /> �'�e�C�r�� � S�n. 7X I��'Bx S9�- /vf s7-v�.,s 9k�sr�' - Gsj�o <br /> Owner MalHnp Addresa Clly Zip Phone <br /> � <br /> ApP��cent Mallinp Addresa City Zip Phone ! <br /> � <br /> ! � �l <br /> Deecdbo Propoeed Work �S—� .Lc�s..a/ f^ - -,F ��,,,,y� <br /> —�' <br /> Project Address pf known), O � � <br /> Altsch lour(4)coplee of plane lor proposed work• Draw lo scale and nole the followlnp as appllcable: � <br /> • P�operty Lines • Cenlerllne ol etreel � <br /> • Outllne and dlmenalone ol ell exleting and • Indiceta North <br /> propo!!d etNctures on ihe lot • Show any proposed p�atlinp chenpea <br /> • Eals:inp and proponed utilltlen • Show meaeuremente � <br /> N 1 L HI LIN <br /> PERMIT CONDITIONS O <br /> 1. All calle for Inepectlon ehall be mede 24 hrs in edvence•phone�59•8815. � <br /> 2. All work ehall be peAormed In eccordance with Ihfs permit and current City ol Everetl Deslpn end Conet�uctlon <br /> Standerds end Speclficatlona <br /> � 3. Call Locatlon Underp�ound Service 4B hra belore you diB.TOLL PREE NUMBER 1•800�424•SbBb. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby egieea to hold and eave harm• <br /> less the City ol Everell Iram any and all clalma for damapes, costa, <br /> expenses. or causea ol actlo� Ihat may arlse becauea ol Inalallation <br /> ����_� J� �� �6 and maintenence of tha improvement or othe�riphl-ol•way usa herelo <br /> applletl lor and lurther eBrc�ea to remove aame upon notice Irom Ihe <br /> �Approved forCon ruction Dete City and to replece public property damaped thereby. <br /> / <br /> �«"e�� J/J � � � �/�!/V <br /> LINSPECTION <br /> Approved as Conatructed Date Sig�re`ol Applicanl � ° � <br /> evereft PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BF STARTED WITHIN <br /> � 3200Ceda�Streel 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THI3 PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY TH[CITV UPON ANY STOPPAQE OF WORK ON THI3 F� <br /> PROJECT OVER 90 DAYS DURATION. f <br />