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Date_��� 9.S
<br />Anplir,alion For
<br />PUBLIC WORKS PERMIT
<br />Print or Type Only
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<br />Prolect A ress Irl known: _..__. __ __ _ _ _.__ 't ` � ��
<br />Attach fwr 141 eoP�es ol Plans lo� proPose;l �ti�r. . D�av. lu _.-,tl.� .n,.� n�.�., tn��'oilo:nny n:� aGUnrab�e /1%�J ��(/C/l�
<br />• Prooerty Li�ies • C�.,.t�•�t:ne nl sireet BL✓�
<br />• Ou;hre : nd dimen5ion5 0� dll exi5;mq ;ntl • I��tl�rnie Nr.rih
<br />oroposed sVuclures on �he loi •�ncnv nny nrnnCsed i)ratline7 chanqe;
<br />• E�isling and proposed Wdities • Shov: inea;urpmenls
<br />L�OW iHIS LiNE
<br />PFRMIT CONDITIONS
<br />1. All calb lor inspection shall be made 24 hr;, in advance phone 259•0810.
<br />2. All work shall be FeAormed in accoroance wilh this perm t and current City of Everell Design and Construclion
<br />Standards and Specilications.
<br />3. Call Location Underground Service 48 hrs. before y;u dig. TOLL FREE NUMBER 1•800•424•5555.
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<br />Approvedto� r�HGc��.on.
<br />C� " �
<br />FI L I . O '
<br />Approved as ConsVuctc
<br />PUBLIC WORKS �EPARTMENT
<br />,��� 3200 Cedar Sireet
<br />� Everetl, WA 98201
<br />Phone:259�8810
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<br />ACKNOWLEDG[PdENi OF CONDITIONS
<br />+n,. �n��1r.�-_iy�i���l wmeVapplirP�nt hereuy a[�rees to hold :lntl s�.e harn��
<br />-- — - - - -- --- -., I�^.•, ;h�. Gdv �� [veretl Irom any dnA .II daims tor damage:,. ;:Osls
<br />� �, o=i,ens��a or causes ol achon that may anse be[ause ol inscdlation
<br />�i� � and maintonanr.e M �hn improvement or other nghl-o��woy use h�ne�o
<br />�S S �,ir�r�-n,; fnr and lurtner nqree5 to remove same upon notice irom ihF
<br />���O,d�� � r�., im! u� n,nl,ir,�� p�ini�,: ProPertY dama9ed IherebY.
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<br />j Si4i�. Iu�n o' Appli ,an! DatC
<br />IYGFY. �A11'� - iD BY iH15 PERMIT MUST BE STARTED WITHIN
<br />I vi0 D�AYS OF DA [ PERM1IIT IS ISSUF� AND THEflEAFTER IS TO
<br />I ac' QILIG[NTL1' PURSUED 70 COMPLETION. THIS PERMIT fdAY BE
<br />, G1�JCELLED b'I THE CITY UPON ANY STOPPAGE OF WORN ON THIS
<br />��. P�70JEG70VEF 90 DAVS DURATION.
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