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D0'B�'� PnpIK Worht Permil• � _�/� '— <br /> Applicalion For o�eu oeoi • y J <br /> PUBLIC WORKS PERMIT PueTOI�Fee`ee s <br /> R leea�pPl FeePerd S <br /> Print or Type Only T� �VSTING_. 3 �3 � B.'"""o�. s ZD�— <br /> Nqnl �ir_P �SU� C�P���hMN tvPlA�' qR2Cl/ �Sa -3�y�r <br /> , Owne� MaihngAddress Cny Z,p Phone <br /> �loho� "� <br /> � APPllcent Mailing Address Ci�Y ZiP Phone ' .. .. <br /> j� <br /> Desc�ibeProposedWork I ihQ IMpVP' <br /> Projec!Address pl known� v�.�/ol C IP JOIb�� t�,r� � <br /> ii- � <br /> A l t e c h f o u�(4)c o p l e s o l p l a n e l o r p r o p o s e d w o r k� D r a w l o s c e l e en d no ta t he lo l lowing es epplicable: � <br /> , � Property Lines • Cenlerline ol streel � <br /> • Oulllne end dimeneions ol all existing and • Indicete Norlh <br /> propoaed alructures on the lot • Show any proposed greding chenge�s ! <br /> '� • Exlnling end proposed ulilities • Show meaauremenls � <br /> � DO NOT WRITE BELOW THIS LINE <br /> �, PEFMIT CONDITIUNS O <br /> 1.All calls for Inapection ahall be mede 24 hre.In etivanca-phona 259•8810. � <br /> 2.All work shall be peAormed In accordance wllh thls permit and current l;ity of Everetl Design and Constructlor <br /> � StenderdaentlSpeclflcations. <br /> � 3.Cell Locellon Underground Service 4B hrs,belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � �!`. [mvrtont/Jovf'� 062�1,,,-J'�oo.�Z'o .to .rce�. ,tv�y O <br /> ' S � � ��. � �; �.�.,,�c, .zo d�, H <br /> � � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF LONDITIONS <br /> The unde,rsigne•d owner/epplicnnt 7ierehy agrees�0 hold entl seve h0rm- <br /> - less the City ot Evcretl Irom eny and a" claims br demages. cosls, <br /> // ,,r��7_ �J eMpenses, or causea ul ection Ihal mpy �se beceuaa of Inslallafion <br /> �i��.�%JOO/71L •� �� and maintenance oi Ihe imProcement or othr.r right�o��waY use he�elo <br /> eppliod br end Iwther agreas to remove ,ci�o upon no�ice hom the <br /> App�cvetl lor onsiructlon, �B�e City end to re e pubhc prope�ty demnged Ihe�eby. <br /> v � <br /> , <br /> �.- ;���,e� `/� <br /> FINAL INSPECTION pe�e � ( ) � 5��� (� <br /> Approved 86 Consiruc�ed Sipnalure ol App icent <br /> Dele <br /> evemtt PUBLIC WORKS GEPARTMENT WORK AUTH0512E0 BV THIS PERMIT MUST BE £TARTED WITHIN <br /> � 3200CederStree� 180 �A'iS OF DPTE PEAMIT IS ISSUED AND THEREAFTER IS i0 <br /> Evare�t WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS r'ER1.11T MAY BC <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI' <br /> PROJECT OVER 90 DAVS DURATION <br />