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Date ��� C%� <br /> �,.�,,, ,.,�•.,��...m <br /> HPPIiC�LCn FOi 9��g Den� � ����_�_, <br /> PUBLIC WORKS PERMlT P���,�w�,�,�n ---- -- <br /> ,o�.���� s_. <br /> lass nnni �e.ve�a 5 <br /> Print or Type Only o,�.���.Po„� S <br /> -���5 rYY��(-r►� a��� a�2��u Y�.c/ �'� �� �r8201 ��'j <br /> Owner Ma I ng Adtlrc.,s Ci�y Lip Phone <br /> Applir.anl Malhng Addre55 uty Lp Phone <br /> Descnbe Proposed Work �lL�1 I( JI � � <br /> ✓ � <br /> Pro�ect Atldress Id known� _. - � <br /> Attach four 141 copie,oi plans for proposr.d wo�!:- Draw to scale and note Ihe fo owmg as appficable. � <br /> • Propr.rty Lines • Centerl�ne of street � <br /> • OutLne and dimensiuns of all existing antl • Indicate Nonh <br /> proposed structures on ihe!ot • Show any proposed gradiny changes <br /> • [.�sfing and proposed utildies • Show measurements � <br /> DO NOT WRITE BELC�W THIJ LINE <br /> PERMIT CONDITIONS O <br /> 7.All calls lor inspection shall be made 24 hrs.ir advance-phone 259-881Q. � <br /> 2.All work shall be peAormed in acwrdance with this permit and curmnt City o'Evereft Design�nd Construr�ion <br /> Sta�dards and SGeciflcations. <br /> 3.Call Location Underground Service 48 hrs.before you dio.70LL FREE NUMBER 1•800•424•5555. � <br /> i�-� v�-Q��.I,C,jI�C� /� / 0 <br /> ��-l-z�4/Gri''- -�� � <br /> J � <br /> �/1. � �^� <br /> / / � <br /> O <br /> a <br /> ACKNOWLI'_DG[IdENT OF COI�DITIONS <br /> The undersigned owneUaDP6cant hereby agrees to hold and save harm- <br /> — less ihe City ol Everetl irom any and all claims for damages. costs. <br /> expenses, o� causes ol action ihat may arise because of installation <br /> and maintenance of the imp�ovement cr other right-obway use hc-eto <br /> applied �or and furiher a rees to remove same u on notice Irom Ihe <br /> Approved lor Construction Date City and to replace pubh 9p�operty damaged Ihereby. <br /> FlNAL INSPECTION Date <br /> AaProved as Constructed Signature ol Apphcant Date <br /> ev�mn PUBIIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarStreet 180 DAYS OF DATE PEAMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA 99201 BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY 7HE CITY UPON ANV STOPPAGE OF WORK ON TH:S <br /> PROJECT OVER 90 CAYS UURATION. <br />