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D8t@_��'`�6 PoEtic Worb PvmO• " ����/ <br /> , Appllcatlon For eieo.o•o�-• <br /> PUBLIC WORKS PERMIT °°°"°""°'".°.. <br /> .o�.�F.. • <br /> L�u�oolfnP�W /�� <br /> B�I�ne�Du� � �D�� <br /> Prfnt �:r 1"ype Only <br /> � {, � N s�R,A �✓v ao2 a ,a,�RSoN �'�Q,cer,-. 9�'��� 2s� _��s <br /> ONner MeI1lnpAddrees City Zip Phone <br /> .�ilz.�al4,' Ati�r� 2e'L �LL��I� Sei,� ��Q�n q �to � �• SZ- �7z7 <br /> P �plicent Malling Addreae Clty Zlp Phone <br /> Deac�ll: i Propoeed Work � �`� S �F� �' D rt I✓ Q � � <br /> -. - W <br /> Proleet �ddree,�1I known� � L� t^v ` � <br /> Attach I �ur(4'-coples of D�ene lor propoaed work•Drew to ecele and note Ihe followinp ea appllcable: � <br /> • ��roperty Lines •Cenledine ol atreet <br /> � Outline and dimenelone of all existlnp end • Indicate Norlh <br /> propoeed etructuree on the lol • Show any propoaed gradinp chenpes <br /> • Exietlnp and proposed ulllltles • Show meaeuremente � <br /> �� HI L <br /> PERMIT CONDITIONS O <br /> 1. All calle lor inepectlon ehall be mede 24 hra In edvance•phone 2S9•BB15. � <br /> 2, All work ehall be Oerlormed in eccordence with thle permlt end current Clty ol Everett Deslpn and Conetructlon <br /> Stende�dsend 3pedflcaGona <br /> � 3. Call Location Underpround Service 4B hra belore you dig.TOLL FREE NUMSER 1•800�424•5dba. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDOEMENT OF CONDITIONS <br /> .��„(. _ The undersigned owner/appllcant hereby apreee to hold and save herm- <br /> �� lesa the City of Everelt irom any and all clalme for damapee, cost4 <br /> .�J expenaea, or caueee ol ectlon thet may erfse becauee of installallon <br /> C__�•� y,�,�ry_�_ /�� and malntenence ol the Improvemenl or other righhot-way uee herelo <br /> 't�� '� � !� epplied lor end IuAher egreee lo remove eeme upon notice Irom Ihe <br /> Approved or Consir i �A City end to raplece public property damaped thereby. <br /> � � 7-lY f� <br /> fINAL N:PECTION ' Date <br /> Approved .s Conalrucled Slpnature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT �'UORK AUTHORIZED BY tHIS PERMIT MUST BE STARTED WITHIN <br /> everelt 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> 3200 Cedar Strael BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> � Everett.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPA6E OF WORK ON THIS <br /> Phone: 259•BB15 PROJECT OVER BO DAYS DURATION. <br />