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�0�9��� 1 1 ( pubirt WorM�Permlt� � <br /> Appilcation For Biaa oeo� .� � <br /> PUBLIC WORKS PERMIT P�°b.WorA�Fee -- <br /> Tot��Fee 5-- <br /> Le���Dp�Fee P�IE � <br /> Print or Type Only eei��<eo�a ! <br /> �'���/�I �'�I FtIS7�/ ���=� C�N ES`1 N( I7" �-''�I(=1�t=1T ���� ,�5�-.��13 <br /> Owr�er MeIIIngAddreas C y Zlp phone <br /> -�p� F <br /> Applicant Meilinp Address City 2ip Phone <br /> Deecribe Propore�'Work C�A�Af�E AD� �n�n�l f <br /> Pro�ect Addreee(II known) ���3� l_���`J 1 / �+ � <br /> Attech(our(4)coplee ol plane lor proposad work•Draw to acale end nole the following ea epplicable: � <br /> • Properly Llnea � •Centerline ol street � <br /> • Outllne end dimenelone oi ell exieting end • Indlcate North <br /> p�opoend etrucluree on the lot •Sho�+any proposed predinp chenpea <br /> • Exlellnp and propoaed utilitlea •Show mwxeuremente � <br /> 00 NOT WRITE BELOW THIS LINE O <br /> I�� PERMITCONDITIONS <br /> 1. All celle lor Inepection ehell be mede 24 hra In advence� phone 259•8815. � <br /> 2. All work ehell ba peNormed In eccordence wNh thle permil and current City o� Everell Deslgn end Const�uctlen <br /> StenAerde end Specllicatlona <br /> 3. Call Locaflon Unde�Bround Servlce 48 h�s.b9lora you dlg. TOLL PREE NUMBER 1•800•424-5555. � <br /> P����c a.�,rs ���,r .��.PFQ�,,��o ��y-a� O <br /> � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underaigned owner/eppllcant hereby eprees to hold end eave herm• <br /> leae tha City ol Everell Irom any and all clalma for damapea coefe, <br /> expenses, o� ceueea ol ection that may arlae because ol Inatalletlon <br /> and melntenence ol Ihe Improvement ur other rlqhl•ol•way use hereto <br /> Approved for Conetructlon applied lor and lurther apreae to remove eame upon nolice Irom Ihe <br /> Oate Clly end to replace publlc property dameged ihereby. <br /> FINAL INSPECTION Dete <br /> Approvad ee Conalructed Sipnature of Appllcant Date <br /> everett F'UBLIC WORK�3 DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STAqTED WITHIN <br /> � 3200(:ederSt�eet 180 DAVS Of DATE PERMIT IS ISSUED AND THEFEAF',-ER IS TU <br /> Evarett. WA88201 BE DILIOENTLY PURSUED TO COMPLETION. THIS PERMII'MAV BE <br /> P.'�nne: 259•8815 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PPOJECT OVER 90 DAYS DURATION. <br />