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Date�B r�ni,,;wo,w.r+�,mi. _��g— <br /> Applicallon For emc Deo� • _._ _____— _. <br /> PUBLIC WORKS PERMIT �u�bcWoik�fee -- � <br /> ,�,,,,�, s 3/OS" = <br /> ies��ooi��e v�m S�. <br /> Print or Type Only n.�.��,o�a s .�/OS <br /> r� � �/ J�o r3n ��v��s ��� 33yY��o <br /> Ow Mailing Address Gty Zlp Phono <br /> �/�!� o Q �X l�P.vf ��— _��Y- S/,��/O <br /> pplican� Mailing Addre95 City Lp Phonc <br /> r— � <br /> Deecribe Proposed Work v�,{�G%�/�l���D.�/ �r � — L J��f' ___ <br /> _Ja/aL �/�'� /� !/�-.i�- -- -- — <br /> Prolatl Adtliesa lil known) i/__,�C (� ��t/pr� [ /�S'/�A ��U��(L1_ G✓/�/� � <br /> L` e�t .tB � <br /> Altech lour 14)copies ol plans for proposed work� Draw to ecale end nota Ihe lollowing as epplicable�. � <br /> • Property Lines • Centedine ol stneet � <br /> • Outline end dimensions of all erisling end • Indlr,nte !Vorth <br /> proposed niructurea on ihe lot • Shaw eny proposed gradinp changes <br /> • Exisling end p�oDoaed ull�itiea I� Show measurPmenis � <br /> DO NOT WHITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor inaper,tlon ehell bo mede 24 h�s.In advonce-phone 259•881 O. � <br /> 2,Alt work ehall be peAormad in eccordence with this permit end wrrent City ol Everetl Oee:ign end Conetruction <br /> Stendards end Speclflcelions. <br /> 3.Call Location Underground Service 48 hrs.belore you dlg.TOLL FREE NUMBER�-800•42d•5555. � <br /> �, �.�,� �.,�,��-►��r��s �,��� ,�-/ —�� � <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tl�r,�ntlersi9ned owneuappin:ant hereby ac�rees to holtl end seve Aerm� <br /> � I�ss the Cdy ol F.verett Irom eny and all claims �or tlemages, costs. <br /> ' exFenses, or causes ol action ihal may arise beceuse ol instellahon <br /> �/r�-�. / . . <br /> ��'� `7� �� end m.�mtenance al ihe improvemenl or olher right�obwey use he�elo <br /> - � applied lor nnd lurthe� agiees to remove seme upon notice lrom the <br /> Ap ed J.e✓f�on§{r cti � i' � Dat Gty and replace pubhc property damnged Ihereby <br /> J <br /> FINA NSPEGTION�� �������Da� �t+ .� <br /> Approved es Cons�ructed � ture o F u�an ate <br /> everen PUBLIC WORKS DCPARTMENT WORK ORIZ[D BY T IT MUST BE STARTED WITHIN <br /> � 3200CetlerSireel 180 S OF DATE PER T IS ISSUED AND TIIEREAf'TER IS TO <br /> Everetl,WA9B201 BE LIGENTLV PURSUED TO COMPLETION THIS PERMIT MAV BE <br /> Phone.259�8810 CANCEILED BV TNE CITY UPON ANV STOPPAGE JP WORK ON THIS <br /> PROJECT OVEfl 9J D4VS DURATION <br />