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/ <br /> / /B �q PuEi¢Workt Pr�m�1• � �� <br /> �81@ ��� � <br /> B�Cp DeO���—� <br /> qpplicetlon For <br /> PUBUC WORKS PERMIT P��IKWorh�Fea <br /> fot�l iee s <br /> Len�DO�fee PUJ f ,(� <br /> Bei�nce Due f l,LQ `��'�C <br /> Print or Type Only <br /> r y.^�� I � �Jt��1/= �"� �� �0� �'(I9f}�Yx(��.t)1�i.! c� KL� l�>r4 r�� �S'�]- �I�� <br /> Ownur <br /> Mallm9 Address City —� Z�p PhOne <br /> TF✓1�S{L L• .S 6�PQK� � , - /��- <br /> ' PhOne <br /> APPlitant <br /> Meiling Address City Z�P <br /> � , Q,✓ <br /> Describe Proposed Work � ��.� �, L., i/ <br /> �a 1'�ian�( /i %/Jt! <br /> W <br /> Pro�ect Addresa(��known) � <br /> Attach four(4)coplea of plens lor proposed woik•Draw to scale end note the Iollowing as applicable: � <br /> � Property Lines •Centerline ol street <br /> • Indicete North <br /> • Outline end dlmenalona ol ell eAiatinq and � Show any proposed BredinB changes <br /> proposad sirucWree on Ihe 1��1 � Show measuremants M <br /> � Exlatin9 and proposed u�ilitles W <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMITCONDITIONS � <br /> 1.All Calle lor inapedlon ehall be mede 24 hre.In edvence•phone 259-8810. <br /> 2.All work ehell be peAormed In eccordance with thia permlt end current CNy ol Everelt Deelpn end Constructlon <br /> Stendarde and Speciflcatlone. � <br /> 3.Call Locetion Underyround 9ervice 4B hre.before you dlp.TOLL FREE NUMSEII 1•800'4�4'a6 . <br /> � p,,.ry ��..� ..�, ..�� 2� � �-U P���w � <br /> �,.�,,.�..�— .���� �t,�- �,"r"-` ���I H <br /> �� �� �a ��-�-/���.�, N <br /> S n� c.�.�� d.�p�G�, ,l�-o'.�- �.P`�c.�E`T� � <br /> � , a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicenl hereby egrees�0 i�old end eave herm� <br /> less the City ol Everetl Irom eny end all claima lor demegea, costs, <br /> e■pensea, or causea ol ecllon that mey erise beceuae ol Inatelletlon <br /> / � � �9 j end maintenance ol Ihe fmprovement or other riBhl•of•way uee hereto <br /> �/�� applied lor end lurther agrees to remove same upon notice irom the <br /> ale City and lo replace Oublic properly demaped thereby. <br /> Approvetl lor C nstruc � <br /> s""' �`/ 1, llt%A��IJ /2t� �`����- <br /> oe�e oa�e <br /> FINAL INSPECTION Signature ol Applicent <br /> ApprovedesConatructed WORK AUTHORI2E� BY THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 100 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Ceder Street BE DILIGENTLV PURSUED TO COMPLETION.THIS PEFMIT MAV BE <br /> Everet6 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAVS DURATION. <br />