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� <br /> D� {�-�// ..)(� PubLc Worwe Permil• �___f� <br /> �/�L...1/ p !-� � <br /> Bma oeo�.•—Ll�_ <br /> Appliwtlon Po� I <br /> PUBLIC 'NORKS PERMIT °°°Te:Feefee , <br /> Lee��00� Fee PeiE S <br /> lte��nce Due S� <br /> Print or Type Only <br /> CL1�=�/l �'l= ('ll��/Z /r�,s'%^' 't!� '✓- / i i ,(i �77 ' � .,��1'" .-i��t r 'X/.�� <br /> Owner Mall�ng nJdreas Cily ZIF Phone <br /> ..:-y�����_'- —.—_ <br /> Applicant Meilin�Address City Zip Phone <br /> Deec�ibe Proposed Work f ��i��'�� ��rl� l- � ��� ' � ��������—�— <br /> ���� - c.�.��. .�A — - W <br /> Pro�ect Add�eas(11 known) �� ' '79�AOr<'on/ sT � <br /> Altach lour(4)copies of plens lor propoeed work• Drnw to scele end nola tha lollowing es epulicable: � <br /> • Properly Llnes • Centerllne of alreet � <br /> •Oulline end dli�enalona ol all exisllnQ and • Indicate North <br /> propoaed elructuree on ihe lot • Show any proposad Breding chenBes <br /> • E�letlnp and proposed utilltiea • Show measuremcnts M <br /> .�. W <br /> DO NOT WRITE dELOW 7HIS LINF. � <br /> PEFiMIT CONDITIONS <br /> 1. All cells lor Inepeclion ehell be mada 24 hrs.In edvence•pnone�5f�•B81 5. � <br /> 2. All work shalt bB pnrformed In accordenca wl�h thla permit bnd currenl City cl Gverett Design end Cons!ructlon <br /> Slendards and Specllicatlons. <br /> 3. Cell Locatlon Underground Service 40 hrs. belore you dig.TOLI FPEE NU'rIBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNO WLEDCiEMENT OF CONDI f10NS <br /> /� The undersignetl owner/apP��cant hereby eBrees to hold and save hxrm• <br /> Iese the Cily of Evere�� Irom any anJ ell cle{ms lor damape& cos1A <br /> e■peneos, or ceueea ol ection that ney erlse beceusx of Inatalletion <br /> ���yY �� 8 J snd melntenance ol the Im�ruvamant or other �ighl�ol•wey use hereto <br /> e��olled lor end turlher ngrees to rem�rve seme upon notice from ihe <br /> Approvad lor C uct e�B City end to replace public property demaged theraby. <br /> " /� s-fj <br /> FINAL INSPECTION Dale <br /> Approved ae Constructed Signeture ol Applicent Delc <br /> WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLIC WORKS DEPARTMENT t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE�' i' TO <br /> � 3700 Cednr Slreet BE DILI3ENTLV PURSUED TO COMPLETION. THiS PEFMIT b,� ' dE <br /> Evere�l.WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE Of WORK ON THIS <br /> Phone:259•8815 pROJECT OVER 90 DAYS DURATION. <br />