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�H�9��� PueiK wo.��P�rm�t• � � L <br /> Bao o�oi.• <br /> Applieatlon For <br /> PUBLIC WORKS PERMIT °�°To,:F::"• • �e� z <br /> Lo.�oo�i«P�W t <br /> B�urm�Du� s ,� <br /> Print or Type Only 7a�p� <br /> �Ir+,•C �. l�I��ryn.�Tf�.�.� /.��7 -���.s ^ H ��- ��O(/le�/l�.l� Sbaii 7�'�' o�J^�� <br /> �` �`O�ef MeillnqAtldreas CI y i:ip P�one <br /> 1/1J�►t ��� Vf,��J2P.1 �A M �. <br /> APPlic�nt Malllnp Addroen C�ly .:IP P�ane <br /> Deacribe Propoaed Wark � �� �� ""'� <br /> W <br />� Pro�eet Addrees pl known) � —� � �����04���d G �,{� � <br /> AM�ch four(4)coplea of pl�ns for proponed work• Draw to scele and note t�ri followinp as applicable: � <br />� • Property Llnes •(:enterline of atreet � <br /> • Oullins�nd dimenslons ol ell exlatlnq and • Indicate North <br /> proposed structures on the lol • Show any propoaed qradinp chanpee <br /> • Ealetinp�nd Droposed utllltles • Show meaeuremente M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITION9 <br /> 1. All cslle for Inepectlon shdl be mede 24 hra In advance-phone 2S9•881 5. � <br /> � 2. All work shsll be paAarmed In accordance wlth Ihla permit and currenl City ol Eve�ett Deslqn end Conatructlon <br /> Stendards end 3peciflcatlons <br /> 3. Call Lotatlon Underpround Service 4B hre.belore you dip.TOLL FREE NUMBER 7�800•424•5553. � <br /> � /�'--'''' �,�oro-�+�� �S O <br /> /� <br /> ` � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIGNS <br /> The undersigne'owner/applicant hereby aqreea to hold and save�arm• <br /> less Ihe City ol everelt Irom any and all clalme lor Cameqe& coet4 <br /> e•penses, or ceuaea of action Ihat mey ariee becauae ol inetallation <br /> •^ � Z_/ Qi/ end meintenen of the improvement Or other righl•01•way uae herelo <br /> � ��T applied lor a ther ap�eea lo remove same upon noUce Irom the <br /> Approve or onatruction Date City and t ublie propert gnd Iherehy, <br /> lL��/ T' 11 . J'T_ <br /> INAL INSPECTION Uate � � <br /> AOVrovad aa Constructad Signature pp icen Dale <br /> everctt PUBIIC WORKS DEPAHTMENT WORK AUTHORI2ED BY THIS PERMIT MUST E STARTE� WITHIN <br /> 100 �AYS OF DATE PERMIT IS ISSUED AND TNERFAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> E•+n�etl,WA 98201 CANCELLED BY THE CITV IIPON ANY STOPPAGE OF WORK ON T111S <br /> Phone: :.59-BB15 PROJECT OVER 50 DAYS DURATION. <br />