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� <br /> Date� uELc Wod�Parmil• <br /> Appllcation For ema oeoi •—Q�T���Fj <br /> PUBLIC WORKS PERMIT P�°,o,°;::`°° ; <br /> Le�e RDO��ee P��U S <br /> Print or Type Only BabnoOue s • <br /> !"]I)��AGI ��DDZ fwl rn�.�di IQO�. L.N�J/� <br /> Owner Mailing Address City Zip Phone � <br /> "1 <br /> ('n,// /_a�.�orr,/1�T�wi�ie�r ?�oG 3fd3 �a <br /> vu. <br /> Applicenl Meiling Atldress City Zip hone <br /> Describe Proposed Work Ne��/m�'/�'�SJ� ��N/�Td� �(j/Y .������,� <br /> Pro�ectAddress�ifknown) �do� wr���,, �^�,�p��(���� � <br /> y � <br /> ■ <br /> Attach lour�4)copies of ptens for proposed work- Draw to scale and note Ihe lollowing os appliceble: � <br /> • Property Line9 • Conferline ol slreet �/ <br /> • Outline and dimensions ol all exlating and • Indicete Norih <br /> proposed etructures on the lot � Show any p�oposed grading chenBea <br /> • Existing and proposed utililies • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All celle lo�Inepectfon ahell be made 24 hrs.in advance•phone 259�8810. � <br /> 2.All work aM1all be peAormed In accordence wlth thle permit and currenl City of Everall Deaipn and Constructlon <br /> Standards end Speclllcatlons. <br /> 3.Cell Locatlon Underground Service 48 hrs.bafore you dig.TOLL FREE NUMBER 1•800�424•SSSS. � <br /> ��t � ,! i� O <br /> �/Cti .Sc� GuOLC y�'�U�. ��ccJ �' �..P2.�,.�-� �� � <br /> �i"o Sti .�Q• L.�2a- c�Ih� on 7�/e yU-ZS B���C�n� � <br /> �LanS - O <br /> T�s ,�....�=���,���� a <br /> 9�,8. 5��`�9/ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant heroby agrees to hold and save harm- � <br /> less the Cily ol Evorett Irom any and ell claims lor damngos, cosls. <br /> expenses, or causes of action that may arise because of inslallation ��� <br /> and maintenance of the improvemenl oi other right�ol•wey use he�ato <br /> applied lor and lurlher agreos to removo seme upon nolice Irom Ihe <br /> Approved br Conslruclion Oate City and to replace pubGc pwperly damaged Ihereby. . . <br /> FINAL INSPECTION Da�e <br /> Approved as Const�ucted Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHURI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everell.WA98201 BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CI?Y UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />