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; <br /> i <br /> DAt6 , — rueo�won.vvmiu __ <br /> Appll�_. ' For eiao.o.w.. <br /> PUBLIC WORKS PERN!!T °°°���•��°�� <br /> .o�.•�s. •— <br /> teu�oo�i�n P�k 5 _ <br /> 9�I�nc�Dun � <br /> Print or Type Only C = <br /> /� �i 1'J/. <br /> %�.e ��i�tie E.irouv � is lc> ����co L�✓�tf 9�'� �e�3� <br /> Owner MalNnp Addreas Clry Zlp Phone <br /> C�rr� �/IS"T�'LlG7`7cTr� o��G ' �(�OS <br /> Applicant Melllnp Addresa L'Ity Zlp Phone <br /> Deecribe Piopoeed Wo�k - <br /> � 1 h/ W <br /> Pro�ect Atl�ireee(il known) _ �1�.�i y�.�,Sy�n pj�010. d � <br /> Attach faur(4)coples ol plane lor propoeed work• Draw to ecele end note the lollowing ae epplicable: � <br /> • Property Llnes • Centerli�a ol etreet � <br /> •Outlina and dlmensiona ol sll eMleting end • Indicale North <br /> p�oposed etructu�ee on the bt • Show any proposed pradlnB chanpes <br /> 11 Ewletlnp e�d propoaed utllitlae • Show meaeuremente � <br /> DO N WRI E BEL W HI LINE O <br /> PERMIT CONDITIONS <br /> 1.All ulls lor Inspectlon shell be mede 24 hro.In advence•phone 26Y-8e10. � <br /> • 2.All worM ehell be peAormed In axorJenca with thia permit and cunent Clty of Eve�ett Design and Conetructlon <br /> 3tanderde and 3pecNicetlone. <br /> 3.Cell Locatlon Underqround 9ervice 4B hre.belore you dlg.TOLL FIIEE NUMSE111-800�4Z4-b65b. � <br /> �, 6 �� � ��� �� �u.,� �-,�a� � <br /> � � <br /> ��� � <br /> O <br /> a <br /> ACKNOWLED6EMENT OF CONDITIONS <br /> The underelgned owner/eppllcant hereby apreas to holA and save harm• <br /> lees tlie Clty ol Everetl Irom eny and all clalme lor damepea coete, <br /> expenee& or caueea ol ectlon Ihet mey arlea because ol Inetelletlon � <br /> end maintenence ol the imp�ovement or other ripht-ol•way uee hereto <br /> applieU for and lurlher egreee to remove eame �pon nollce irom the <br /> Approved lor Conetructlon Defe City and lo replace public properiy damaped Ihe�eby. <br /> FINAI INSPECTION Dete Dete <br /> Approved as Construcled Signeture ol App�lcent <br /> � P1IBLICWORK9DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MU5T BE STARTED WITHIN <br /> 3200CedaiStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EvarotL WA98201 BE DILIIiENTl1' PUHSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:769•BBtO CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJCCT OVER 90 DAYS DURATION. <br />