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Date���LV v 1 �„„ , w�,.,��,�, I `�7�� /!�,1/ <br /> ApUlicalion For ❑'nn n.w • __�I Ll��,��v <br /> PUBLIC WORKS PERMIT ''��^;o„�.;.'�°-:_- _- <br /> lffsl�pl�� f��Pu�1S _ <br /> �.� <br /> Print or Type ONy c,�.��,•m�. S .�6 __ <br /> (�n�/7V'l�l 1� ,1"�� .��D3 C�'1�Stf'tl,�f� r,l1�X[�(}� 4�C`�� - <br /> pW�e� MndingAddress Cily Tip hone <br /> ��VK .I ���1 �� I�dJ��.uLL�� vV — <br /> A�I anl Mallmy Address G ip <br /> ��4V�/�!� � ��v ��� <br /> Descnbe Proposed Work - — _ <br /> Prolect Address Iil knownl ��w '���� " '" � <br /> � <br /> Attach lour(4)cop�es of plens lor proposed work� Draw�o sr.ale anG note Ihe lollowing as apPhcable: � <br /> • Property Lines • Cenlerlme ol slreel � <br /> • Outline and dimnnsions of all e.isting and • Indir.pte North <br /> proposed slruclures on the lol • Show any proposed greding changr.s <br /> i • E��Shng end prOposed u�ihties • Show measurements � <br /> I <br /> 00 NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDI710NS <br /> 7.All celle lor Inspection ahell be made 24 hrs.in edvence•phone 259•8810. � <br /> 2.All wo�k ahell be pedormed In eccordance with this permit and current City ol Everelt OeslBn end Conatruction <br /> Stenderde end Spacilicetions. <br /> 3 Cell Locetlon Underpround Service 48 hrs.belore ynu dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � C C'�Ji��'!�lTic�R% ("�f T</.s' �c:N;�f7l.T tc�itt .Ci-4'(��t£ O <br /> Tf�i FXiSTi.vb Si1�E .SEiJF�' 7-n /5'C= ,{�r_'s�lArfo !d/Ti! � <br /> �Al /IP/�.e��'ED /)7F�rFh'.�J! �.i vA/DF_�C TH•E /3c %LO�.t�� //+ <br /> ts.e Ti1'!IT T.�/� SF_=�uf-iz � .P�=.encirFv 9,e�+vn.•p .�/l'i✓ \/♦ <br /> B[�/epiNe�, � O <br /> �D ��5���� , o� � eP/���'�'P"�'�" a <br /> � � �o � �� � o � � ��� <br /> P � I�' e ACKNOWLEDG[MENT OF CONDITIONS <br /> �, l�� <br /> V� The undersigned owne /nppl�cant hereby ag�ees lo hold end save harm� <br /> less the City ol Eve�ett Irom any nnd all clalms for damages, cosls. <br /> , ,� , e�penses, or cause5 0� xction Ihat may anse becxuse of installatlon <br /> � ^ �,,..��rJ ` � �� and mimtenance ol Ihe improvement or other righl�ol�wey u9a herelo <br /> ' appl�ed �or and lurihe rees to r move same upon noUCe from Ihe <br /> Approved lor Conslr clion Dale City and h replace pron y amaged thereby. <br /> ��—� /U . I z�'� / _/� p�ni <br /> FINAL INSPECTION Date L �d <br /> r,� ur pphcant Dale <br /> OR THORIZED BY THIS PERMIT MUST BE STAF7ED WI7HIN <br /> everrll PUBLICWORKSDEPARTMENT 1H0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CederSireal BE DIUGENTLV PURSUEO TO COMPLETION. THIS PERMIT MAV BE <br /> Everell,WA 99201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�259�8810 PHOJECT OVER 90 DAVS DURATION. <br />