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\f....__-.-..--- <br /> �BtB� .^ ^ �uahc Wm��Permil� __ <br /> AppliCation For n��u oeot .�a� 7� <br /> PUBLIC WORKS PERMIT °°°ra,:F:e`°° , — <br /> �ese�p0�iae P�N f <br /> Print or Type Only H.,�a��e o�e s <br /> �jr'dN ��o,llnerf-ti GyQA/Vn�s�,�/✓DI �✓e/[l� 1.5��339 <br /> �,y�e� MailinqAddress Ctly Lp Phona <br /> �CieA,.�a,;.�Gy�sf N�3/ Np�6�.n, Qd Sn�lu.,��f� 98a9�_ .3 .�..�-o9s� <br /> Appllcant Mailing Address Ci�y Zip —�T <br /> Deecri6eProposedWo�k add nw M QR P ___ _.__ <br /> .� <br /> W <br /> Prolect Address 111 known) � ' � � <br /> Altech lou�(4)copioa ol plane lor propoaed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Linee • Centerline of atreet � <br /> • Oulline end dimenaions ol ell eKisting and • Indicate North <br /> propoeed etructuree on Ihe lot � Show any p�oposed grading chenpe� <br /> • EMiatinp and propoaed utllities • Show moasurements � <br /> DO NOT WFITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All ulle lor Inspectlon ehall be mede 24 hra.in advence•phone 259•8810. � <br /> 2.All work ehell be peAormed In eccordence wllh thia permit end current City ol Evere�t Design end Conatruction <br /> 3tandards and Spacifications. <br /> 3.Cell Lxellon Underp�o�nd Servite 4B hre.belore you diB.TOLL FREE NUMBER 1•800�424•5555. � , <br /> '�i i3 L.� � �0 2�.5 ��-�l�T O <br /> NoT K��� ru�ro �— <br /> ���� � <br /> 0 <br /> ► � ���� a <br /> ACKNOWLEDGEMENT Of CON�ITIONS <br /> Thc unAersigned owner/appllcant he�eby agrees to hold and save harm� <br /> less Ihe Gty ol Everetl Irom any and all claims lor damages, cost& <br /> e�penses, or causes ol ac�ion Ihat may arisa because ol inslaltation <br /> and maintenance ol Ihe improvemont or othar nght�obway use hereto <br /> applied lor and furthe� agrees to remove same upon nolice Irom Ihe <br /> Approved lor Conslruction Dale Ci�y and to replace public propeity damaged iheruby. <br /> FINAL INSPECTION Date <br /> Approved es Const�ucted Signalure ol Applicanl Date <br /> everelt PUBLIC WORKS DEPAFTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CederS�reet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br /> Everet6 WA 98201 CANCELLED BY THE CI7Y UPON ANV STOPPAGE OF WOFK ON THIS <br /> Phone:259�BB10 PROJECT OVER 90 DAVS DURATION. <br />