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�8�@�V u Puohc Wo�h�Permu• p� <br /> � �� �r/O.7 <br /> Applicatinn For eiaa o.o� • <br /> PUBLIC WORKS F�ERIVRIT PuoTolelF:e`°° s — <br /> Le19AD0� �leP�iE s <br /> Print or Type Only aa�•�=�o�. t <br /> �P N l�(� f r�nntPb iJ ��// l,y���PL/J �✓�PA P77 3 SS -p•3FJ7 <br /> Owner Ma�ling Atldress Cily Zip Phone <br /> �C� il�f n ur SuC r�f�io75� �PVP��� � —�.��2`�d, <br /> licanl Mailinp Address ��il) Zip Phone <br /> Describe Praposed Work `�,J�` � QL �QR✓1� � 7L� /)U�/' <br /> � w�l rl 0� E. `��/�.,� n e�1��� _ <br /> — — -- � <br /> Project Atldress(11 known) ___ ������1�L���,6„� - --- � <br /> Atfach low(4)copias ol plans lor proposed work• Draw to s:ale and no!a the lollowinp as applicat le, � <br /> � Property Lines • Cenlerline UI s�reet � <br /> • Outline and dimensions ol all existing end • Indicate North <br /> proposeA stroctures un�he lot • Show eny proposed graj�ng changes <br /> • Exlating and proposed utilitiee • Show meesurements � <br /> DO N��T WRITE B[LOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls lor inspectlon Rhell be made 24 hrs. in advenca-phone 259•861 5. � <br /> 2. All work shell oe perlormed in accr.dance wjlh this permit and wrrent City ol Everetl Design and Construction <br /> Standards end Specifications. <br /> 3. Call Locotion Undarground Service 4B hrs. belc•e you dig.TQLL FREE NUMBER 1•800•a24•$GSS. � <br /> ,'� � � � ���i 8� O <br /> �Lt� �c�/._%s'!/T' j1�T ,/C�Z�L/i��.� <br /> ���1 �' <br /> � <br /> 0 <br /> � <br /> ACM.NOWLEDGEMENT OF CONDfflO^J; <br /> The undersigned owner/opplicanl hereby agrees tu hola antl save harm� <br /> less Ihe City of 'cverell Irom any and all cleims for Aamages, coats. <br /> eMpenses, or cA.ises ol adion �ha� may arise because ol installalion <br /> and maintenance oi ihe imp�ovement or othnr nghPobway use hereto <br /> epplied br end luriher agrees to remeve same upon nolice Irom ihe <br /> Approved lor Cons�ruction Date City and�o replace public properry dameped Ihen�by. <br /> FINAL INSPECTION De�e <br /> Approved as Construcled Signature ol Applicanl Dale <br /> rvrrett PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO dY THIS PERMIi MUST BE STAFTED WITHIN <br /> � 3200 Ceder Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> Everell,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phene� 259�8815 CANCELIED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION <br />