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� <br /> r ��� /,[�. '' <br /> DB�e__y / / Y . Pul�er.Worxe Pnrmit• l�� �70 <br /> Appllcatlon For eien oen� • 3 �� <br /> PlJBLIC WORKS PERMIT P�����K'od�Fee <br /> Totel iee a <br /> Lm�Aoo� FeePaIE S , <br /> Print or Type Only 9el�nce�ue f Z�OD <br /> / !� / �/ <br /> t-�hr,�pm���d� ��,�� ic �� � z�.�-� �v - ���8 <br /> Ownar Malling Address Cit <br /> Y ZiP Phone <br /> � � � J� V. � ` P/�OC .� Ck�G'�f <br /> plicant Mailinp Address Gty ip Pho <br /> c� T� 4��- >>7 <br /> Deecribe PropOead WOrk v /"-� -� -� � ^�_ .,v_ ; (,� <br /> . — <br /> Project Addresa pf known) ��0.1 � �-o'�e��� � <br /> Attach lour(4)coplea of plana lor p�oposed work� Draw to scale end note the following es applicable: � <br /> • Property Lines • Centerline of street � <br /> • Oufline end dlmensions ol ell xxisting end • Indicate Norih <br /> p�oposed 6iructures on ihe lol • Show any proposed g�ading chenpes <br /> • Exlsting end piuposed utllitles • Show meesuremants � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All cella lor inapection ehell be made 24 hrs. In edvance� phone 2S9•8$1 5. � <br /> 2. All work ehall be parlormed In eccordance with this pnrmit end current City ol Eva�ett Deslfln end Construction <br /> Standerds entl Specllicefions. <br /> 3. Call Locatlon Unde�ground Se�vice 48 hrs. 6ebre you dig, TOLL FREE NUMBER 1-800•424-$555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> '�(,� ACKNOWLEDGEMENT Of CONDITIONS <br /> J The undersigned owner/applicent hereby agrees to hold and aeve he�m- <br /> less Ihe City ol Everetl irom eny end all clnims lor damages, costs, <br /> ��// ° �J ��' J- ezpanses, or causes a� ection thet mey erise bacause of InatallMion <br /> � �� � ll and maintenance ol the im rovement or olher ri hl�ol�wa use ha�oto <br /> ������� ��� `'"y� epplled for and further ngrees to re ve sameupon notce Irom Ihe <br /> Ap ovad for Conelructlon Deta <br /> �� City Bnd lo re e,ublic � y dema d thereby. <br /> � —�' /-!�� /: L -Pf� <br /> fINAL'1NSPECTION Dele � �Q�� <br /> Appravod es Conatructed ignelu�e ol <br /> Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTH q .ED BV THIS PE MIT MUST BE STARTED WITHIN <br /> � 3200CederStreel iB0 DAVS OF DA7E PFRMIT IS ISSUED AND THEREAFTER IS TO <br /> Evdret!.WA�J8201 BE DILIGFNTIV �URSUED TO COMPLETION. THIS PCRMIT MAY BE <br /> Phone: 259-BB 15 CANCELL ED DY 7l1E CITV UPON ANV STOPPAGE O�WORK ON THIS <br /> PROJ[CT OVER 90 DAVS DURPTION. � <br /> L <br />