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� <br /> r _/ _ _-- - -_. '' <br /> Date///�/� ` �L7/�� _ <br /> / PuUlrc Wort�Permu� _(i/ <br /> APPlicallon For e1av o•o�.•— _ <br /> PUBLIC WORKS PERMIT P�m�cWorw�Po� <br /> Tohiiss � _ <br /> �����DDI FIu P�IE �1 <br /> Prinf orType Only <br /> B�I�nN Du� j <br /> � � � 1�� sS��3 q L.��-Il�,�tc �j� -�-IIA�k, <br /> Ownar Malllnp Addresa Cily 2ip Phone <br /> C���. \�ew��vv�.. ��a. So� 17.�1,`j—�..4,-� ��20� �.��-3�1, <br /> Appllcent Mallinp Adtlreas Cil � <br /> n Y 21P Phone <br /> Deecrlbe Propoeed Work ""'�-'`� �H� —'� <br /> Pro�ecl Addresa pl known) ` \ � � <br /> Attech four(4)coplea ol plene lor propoaed work-Drew to acele end note the lollowing es epplicable � <br /> • P�operty Llnxe • Centerline of slreel � <br /> • Outlfna and dimenelona ol all existing end • InJicate North <br /> propoaed etructuree on Ihe lot • Show eny proposed gredinp changea <br /> • EMletinp end propoaed utililiea • Show meesurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMI7 CONDITIGNS O <br /> 1. All calle for Inepaclion ahall be meda 24 hra. in edvence� phone 259-8815. � <br /> 2. All work Bhell 6e paAormed In eccordance with this permit and current City al Evarelf Design erd Construclion <br /> Standarde an0 3pecillcations <br /> 3. Call Location Underpround Sarvlce 4B hre.bolore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �, ��►� a/��'o-.-�d ��IGnS r��.�P� G G�¢ O <br /> / <br /> ♦�A <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITION:t <br /> Pie underaigned owner/epplicanl hereby eprees lo hold and seve ha�m� <br /> � less the Cily ol Everelt Irom eny and ell claims lor tlemeges, cosls, <br /> ezpenges, or causes of action Ihet may e�ise because o� inslelletion <br /> 7 � end mamlenance o� fhe improvement or other righl�obway use herelo <br /> apP�ied lor entl lurther a rees lo remove same u on notice Irom Ihe <br /> Adp ov9 on truc ' n Date Cily end b replace publiceproperly damaged thera6y. <br /> � � ) -. <br /> '�`jC`7 '1 \Z e <br /> FINAIIN ECTION Dete �'� <br /> App�oved ee Conetrucled \. Signa�ure o�Applicxnl Dnte <br /> everett PUBLIC WORKS DEPARTM T WOPK AUTHORIZED BV THIS PE MIT MUST BE STARTE� WITHIN <br /> � 3200 Cader Stree� 1B0 DAVS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere�l,WA 98201 BE DIUGENTLY PURSUED TO COMPLETION. iHIS PERMIT MAV BE <br /> Phone: 259�8815 CANCELLED BY TH[ CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PFCJECT OVER 50 DAVS DURATION <br /> L '� <br />