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�8�8�� Pu�iic Norhe Permit• 4o%Cv <br /> TO POSTING ''� '�� Bmc Oep1 �� �� <br /> Applicatlon For � <br /> PUBLIC WORKS PERMIT 'unic�Fnere� : �, i ?— <br /> I «„���,� r..v.� s J—�i <br /> Belence Dur S /5�/�" <br /> Print or Type Only <br /> CR4;rtf/ l�o� L� r1�nC�s�;� c�l�e� l���.f�...,S�SoK�.4/....Qkk , S,Iryao <br /> T i �rn �%�is � �r [ d� �Q3 o7oZ-e�,1,7.8- <br /> Owner Mailing A dress CdY �P Phone <br /> i Rf%NryNnJ%[J �.Jlrl—���ST ��QfC �/���//l�� 9dai,� �i ��/Y/7 . <br /> ADPlicdnt Mallmg Address City Zip Phone <br /> /�I � 2_ (��,In��.�b `�5-uN��' n�D.�rwwf Cd a/n y S�J�4C l5a -�9' <br /> Deacrlbe Proposed Wo�k I.y PLi <br /> /9/D- C�/ CAsi.vo .P W <br /> Project Addresa 1�1 known) <br /> �� � <br /> Atlech lour(4)coplea ol Plens lor proposad work•Draw lo acale and note Ihe lollowing as applicable: � <br /> • Properly Llnea � Camedine ol slreel � <br /> • Outline end dlmensions oi ell eaisting end • Indicete North <br /> p�opoead struclurea on tha tot • Show any proposed grading chenges <br /> • Exiatlnq and proposed utillliea � Show measurements M <br /> W <br /> DO NOT WRITE BELOW TNIS LINE O <br /> PERMIT CONDITIONS � <br /> 7.All cells lor Inapectlon shell be made 24 hre.in edvence•phone 259•881 O. <br /> 2.All work shetl be pertormed In eccordence with thia permit end current City oi Everett Ccaign end Conatructlon <br /> Slanderds end Speclficetlona. � <br /> 3.Call Locatlon Underg�ound Service 48 hre.belore you dig.TOLI FREE NUMBER 1•800�424•5555. <br /> � <br /> �, I�' a�,niaw4/� �«s o� � � � �y° 0 <br /> / <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLFDGEMEN7 OF CONDITIONS <br /> The undersigned ownedayPlieenN+ereby agrees to hold and seve harm� <br /> less Ihe CitY of Everell Iram any end all cleims lor damages. costs. <br /> e■penses, or causes of action thel may erise becauae of Instelfation <br /> � end maiMonence ol �he improvument m olher righ4obwey use herqlo <br /> eppllea for and lurther agrees to remova seme upon notice Irom Ihe <br /> r tl o uCti Dete Cily and to. place public p� rty dama ed ihereby. <br /> !� � � _ ^ >J � � <br /> /L � — � � <br /> F AL SPECTION De� ��45! 4 R'.� K�/�.ot� <br /> Approvad ae Conatructed Signawre of Apphc nt �... M• <br /> WORH AUTHORIZ[D BV TNIS PERM�T MUST BE STARTED IiHIN <br /> everelt PUdLICWORKSDEPARTMENi 180 DAVS OF DA7E PERMIT IS ISSUED ANO 7HEREAFTER IS TO <br /> � 3200CederStreel BE DILIGENTLV PURSUED TO COMPLETION. 1NIS PERMIT MAY BE <br /> Everell,WA 90201 CANCELLED BV THE CITY UPON ANY STUPPAGE OF WORK ON THIS <br /> Phone:259�8810 PPOJECT OVER 90 DAYS DURATION. <br />