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�� ����p � I puplfcWOA�Vom11I � <br /> D9tB—a+f+".�1 BIOi.D�OL�ql/ZBiQ� <br /> Applicetlon For <br /> PUDIIc Woha Fn <br /> PUBLIC WORKS PERMIT To,.,F.. • <br /> Leu�DOI fM P�M { <br /> �n.��.o�. • <br /> Print or Type Only <br /> 3�2-5878 <br /> ,� g�� pp. p0 Box 3707 S OF-76 Seattle CWA 98124 Z'P Phone <br /> ��ef M�IHnp Addreas <br /> ApD����� Melllnp Addreae <br /> Ciry Zip P�one <br /> Ds�crlbe P�opo�ed Work <br /> � <br /> Pro�eet Addrose(N known) � <br /> Ati�ch four(4)coDbe o1 Dl�ns for proposed work•Drew to ecale and note�C n�`°Wine of tpeet�ble: � <br /> • Prop�rty Lln�e �Indlcate North <br /> �putlins�nd dimenNons ol NI axletlnq end � Show any proposed predinp chenpee � <br /> � propopd atructum on lhe lot �Show messuremente <br /> •Existinp�nd propossd utllilles <br /> O <br /> pERM1T CONDITIONS ' <br /> 1.All pN�fa Inp�cllan aMll bs m�ds 2�hn.In Wwncs•Dhone 16�10. <br /> 2.All wak k�ll b�P���^°d In�ccord�nce wlth thb permit and curtsnt Ciry of Ewrott DnWn�^d Co^�1�10^ <br /> �,.�.�..��.�«��.. Z <br /> 3.ull Loation Und�rOround Ssrvke 49 hn.bNors Yo�dia TOLL RII[[NUM�E111�OG'4Z • <br /> �- �� �� � � <br /> ��� � H <br /> //-2�- 9i � <br /> � <br /> � <br /> ACKNOWLED6E <br /> MENT OF CONDITIONS I <br /> The underelpned owner/applicant hereby aprees to hold and eeve harm- <br /> leas Ihe Clly ol Everett from anY and all claima lor dam�pea coeta <br /> expenae& or causee ol ection thal may arlse becsuse of Insta�lation <br /> and mainlenance of the improvement or other riqhl•^�•^oticeelromf tbe � `�� <br /> apPlled for and tuAher aprees to remove aeme upo .-�,� <br /> ppproyed for Contlructlon Dale CitY end to replece public property damaped thereby. ��,,�� <br /> =h <br /> i <br /> Oete Date �,',� <br /> FINAL INBPECTION Slpnalure ol Applicent <br /> ppproved ee Conslructed WORK AUTHORIZED 8Y THIS PERMIT MUBT BE STARTED WITHIN , <br /> PUBLICWORI(SDEPARTMENT 180 DAYS OF DATE PERMIT IS IBSUED AND THEREAFTER IS TO <br /> � 3200CM�r8treH BE DILI6ENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> EverotL WA 88201 CANCELLED BY THE CITV UPON ANV STOPPA6E OF WORK ON THI� <br /> Phone:269�8810 PROJECT OVER 90 DAYS DURATION. <br />