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� <br /> � .,, <br /> �8�@�V J PUGI¢WorM�Parmit� __ <br /> Appllcallon For Biau oaot ._L�«� <br /> PUBLIC WORKS PERMIT PublicWa�M�iN _— <br /> Teb�Fee � <br /> Leu�pD�iae Pua � <br /> B�bnce 9ue 6 <br /> Print or Ttipe Only <br /> ���n .,,�� � _ r+� /��/�y /� � /�� l ,��,Na��rc� y� G��a 7�`� l�'J9� <br /> Owntn �itallinpAtldeas Cily 2ip phone �C <br /> /a � — <br /> P-nc��-e /_s I� /s�ai- �� b-l� ��,<e� /.,1�ra�,,,�,i�e u���,r�,� Si�b <br /> AVP�cant / Meilinp Address Cily Zip Phona <br /> �/ I .�'�V��[. �,v;6 9,v <br /> Descrlb6ProposedWork ��_y'J(y{�� /��a]/r��d0_�/AT ��T � (� 11i//Y�lAl����(� _ <br /> .-7 <br /> ProfectAddresslifknown) �LJ�� r, l (Xll1!/: f��� `�'� � -- � <br /> � <br /> Attech low (4)copies of plans lor proposed work-Draw to scale end note tha lollow�ng as epplicab'�e: � <br /> M Properry Lines • CeNe�hne ol street � <br /> • Outline and dimenaions of all exls�InB and • Intllcaie North <br /> proposad etruclu�ea on Ihe lot • Show eny proposed grarfing chenges <br /> • E��'cting end pmnosad utilillea • Show measuremenle � <br /> � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls lor inspectien shall be mede 24 hrs. in advence• phcne 259•8815. � <br /> 2. All work shall be performed in eccordence with Ihis permit vntl curront Clty of Evero�t Design and Construct�on <br /> SlanAarda end Specifications. <br /> 3. Cell Locetlon UnAerBround Servlce 48 hre. belore you tl�d.TOLL FREE NUMBEfl 7-800•424•5555. � <br /> /vO �U•GQGiG Gf�O/'�s �F/'��i7 if.'•'n(j�.�"r=lJ O <br /> ���fs6 <br /> � r ��i� <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersign=d owner/applicant hereby aBreea to hold and save herm• <br /> — less the Cily ol Everell Irom eny end all clalms lor dame0es, cosls, <br /> r,zpenses, or causes of action thet mey drlse because ol inslallation <br /> and mainlenance ol �he improvement or other righPobviay use hereto <br /> npplied lor and lu�iher agrees to remove same upon nolice Irom the <br /> Approved lor Consiructbo Dale Ciry and to replace public property damaped ihereby. <br /> FINAL INSf'ECTION Dale — - <br /> Aoproved as Conslructed Signature ol Applicant Dele <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Ceder S�reet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everetl,WA 98201 BE OILIGEN7LY PURSUFD TO COMPLETIC�N.THIS PERAIIT MAV BE <br /> Phone: 259�P815 CANCELLED BY THE CITV UPON ANV STOF'PAGE OF WOFI<ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />