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Date � <br /> F�OI.c Wor4�Pnmll� _ <br /> Appllcelion For aieo.p•o� . <br /> PUBLIC WONKS PERMIT �°;,;f �F�� s — <br /> ln�Appl i��P�M � <br /> Prfnt or Type Only e.u�.o�. s <br /> Plp�n Check No� 8 3/803/2 ggpA <br /> Owner �pJobCl�lddras�: 25106iI9CA6IN0 Rp <br /> Phone <br /> � Ownore OTE • <br /> T�nent� <br /> Ds�c��fdWorkt �IN BHSLT6R <br /> Applicant pUELIN6 MEA CANOPY - 9008F Phone <br /> Descrlbe Proposed Work _ OFlIC6 8ST JOB SET <br /> APPROVED !OR PEqM1Tt D11TE_/_�_ gy <br /> - � W <br /> Pro�ect AAdress(if known� � __ � <br /> Attech four(4)coplee of phne lor p�oDosed work• Draw to ecale ana note the lollow�np ae applicablo � � <br /> • Property linee • Centerline ol atreet � <br /> • Outlins end dlmenelom ol all eMlsllnp�nd • Indlcete North <br /> � propoeed el�ucturee on Ihe lot � Show eny proposed prading chanpes <br /> • Exlstinp and propoaed utllilles • Show measurements � <br /> DO NOT WRITE BELOY!THIS LINE <br /> PERMIT CONDITIONB O <br /> 1.All cdU lor Inepeellon ehsll be made 24 hro.In edvance•phone Z69-8310. � <br /> 2.All work ehdl ba pedormed in accordence with thls permit and cuvent Clly of F;��rrett Oesipn end Conetrudlan <br /> St�nderd��nd 3paciHutlona <br /> , 3.CHI Loc�tlon Underpround Servlce 4B hn before you dlq.TOLL f11EE NUMt�I'111-800�424�SSSS. � <br /> .�U� ��"v"' �Fiu"�I' cC1C/L!'4N���/ .L?/1,f.cCe�/ O <br /> G� <br /> . ��.J � <br /> 1 /7 %� Z <br /> O <br /> a <br /> ACKNOWLEDCaEMENT OF CONDITIONS <br /> The underolqned owner/aOPlieant hereby apraea lo hold and eave harm• <br /> leea I�e Cily ol Everett Irom eny end all clalma lor tlemage0. coste, <br /> eKpeneen, o�ceuaee of acllon that may arlee because ol inetallatlon <br /> end malntenence ol tho Improvement or olher right•of•way uee hereto <br /> applled lo� and lurther apreee to remove same upon nollce f�om Ihe <br /> APproved lor Conatructlon Dete Clty and to replece public property damaped ihareby. <br /> FINAL IN3PECTION Date <br /> Approved en Conetructed Sl�uaturo ol Applicanl Dete <br /> PUBLIC WORK9DEPAATM'eNT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Ceder3t�ee1 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet4 WAB8201 BE DILIGENTLY PURSUED 1�0 COMPLETIUN. THIS PERMIT MAV BE <br /> Phone:268�8810 CANCELLED BV THE CITY UPON ANY u?OPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> J <br />