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r <br /> �BfB�� � � v�eue wo�w�v.��u• 'i <br /> eiau.ono�.•� ��� i <br /> AOPlicatlon For <br /> a <br /> PUBLIC WORKS PERMIT `°°Ta�F:`•' . <br /> L�uADOI f��P�Id { <br /> BUN�t�Du� /� <br /> Prfnt or Type Onty <br /> /ylAx�n lr Mql!! <br /> 71v �n .� o (�n F� 13ox 3 70 7��11.:�.L�.�.a�Le�-��a�r�,�� � 3No2-f.4�-7�— I <br /> Owner MalHnq Addresa Clty 21p Phone <br /> Sa ,.„,P - <br /> Applitant Mailinp Addreee Clty Zip Phone <br /> Describe Proposed Work ��� �'� �n--.--��� ��� ����a <br /> i <br /> ,I <br /> i <br /> � <br /> WI <br /> Pro�ect Addross pf known) � <br /> Att�ch lour(�)coplee ol pl�ns lor propo�ed work• Draw to ecale and note Ihe lollowlnp as eppllcable: � <br /> • Property Linee • Centerllne of etreet � <br /> •Outllne end dlmenelons ol ell exlslinp and � ghow eny p opceed pradlnp chanpee <br /> proposed etructuree on the lot � � <br /> • Eeletlnp�nd proposed utllities � • Show meaeuremente <br /> N I L I LI O <br /> PEqM1T CONDITIONB <br /> 1. All cdle for Impsctlon shall be made 24 hra.In edvence-phone ZS4•88/6. � <br /> 2. All work ehsll be peAormed In accordenca with thls permit end current Clty of Everetl Deeipn and Conalructlon <br /> Standeids�nd Specllicatlona � <br /> 3. Cell Locetlon Underpround Servlce 4B hra before you dip.TOLL f11EE NUMlEII 1•BOO•4Z4•asas. <br /> �'�Bt�c wo,e,e-s PE,c.�.r ��' ���� �� O <br /> i 9-B� � <br /> � <br /> O <br /> a <br /> ACKNOWLED�EMENT OF CONDITIONS <br /> The underslpned owner/epplicant hereby agreee to hold end save herm• <br /> leee the City of Eve�ell Irom eny and all claims lor damepea, cosls. <br /> expenaea, or causea ol action Ihat may erlse because ol Inslalletion <br /> and maintenence ol the Improvement or other righl•ol•wey use herelo <br /> epplleA lor and fuAher apreea lo ramove eame upon nolice Ircm the <br /> � Approved lor Construcllon Date City antl to replace public property demeped thereby. <br /> P���� ��� °� <br /> FINAL INSPECTION Date De�e <br /> Approved ea Constructed Slpnalure ol Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE $TARTED WITHIN <br /> eveielt PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PEFiMIT IS ISSU[O AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-0815 PROJECT OVER 90 DAYS DURATION. <br />