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� . • <br /> Dete wexcwoM.w�n. �� <br /> i � ApPllcation For �o�.• <br /> � • PUBLIC WORKS PERMIT �°;o;„`�° . _ <br /> �...�wF«�.bs� <br /> s.u�.o�. t � <br /> Print or Type Only <br /> To Bi5 lcaNst�rE� <br /> Ld�. <br /> T�ie BDein• Co P0. 8aX97o7 MSc�-7b ��fYe.l,�Aa. $/tt�-22o7 .3S�2-SBi19 <br /> Owner MalNnp Addrees City Zip Phons <br /> lEN. � 66�.f.5Y.! <br /> So•r,`. <br /> Applicent Mellinp Addreee Clty Zlp Phone <br /> DeecrlbePropoeedWork T/'f��G Son� /nSftaLL4fi0I7 Q�C� Wi�eninr <br /> p�f' 7'SL�S! Str� Q! �fie in�rrsee�.�'on ef .I'�e�.�.� <br /> W <br /> Prolect Addrese(II known) `��� � �� � o V �' � <br /> Attech four(4)coples of plens for p�oposed work•Drew to ecale and�ota the lollowlnp ee epplluble: � <br /> • Property Lineu • CenleNine ol elreet � <br /> • Outline and dlmenslone ol all exielinp and • Indicete NoAh <br /> propoeed tt�uctu�es on the lot • Show any propoeed predlnp changee <br /> • Exletlnp and proposed utllltiea • Show meeeurements � <br /> O NOT WRITE EL HIS LINE O <br /> PERMIT CONDITION8 <br /> 1.All qlle for Inspectlon ehsll be mede 24 hn.in eJvance-phone 769-881 O. � <br /> 2.All work ahall be performed�n accordence wlth thle parmit and curtent Cly of Everett Deelqn end Conetructlon <br /> Sfanderdt�nd SpeciHcatlona <br /> 3.Cell Locatlon Underpround Service 48 hre.beloro you dip.TOLI FIIEE NUM/E111�00�42I�SS68. � <br /> � w�,F .� 6.� �.,�, ,�.,�..�- �.�.�.v �y � <br /> f'G�t�l�"` ya,��c, tct,r,f.t c,,, /2-za=y/ <br /> a,��� �D ~ <br /> ' 1992 � <br /> , JAN 6 . <br /> I , ......Y..oF••Ev�a�n Q �. <br /> J ,•�IT plvi�lo� ��V <br /> sulldln0 <br /> �0 <br /> ACKNOWLED(3EMENT OF CONDITIONS <br /> The underelq�led owne�/applicanl hereby aprees to hold and eeve herm• <br /> lees the City ol Everelt Irom any and al! clelms far damapaa co�ta <br /> expenee0. 0� causes of action Ihat may arise because ol Installatlon <br /> � � �2� Z and melntenance of Ihe improvement o�other rlpht•of•wey use hereto <br /> � applled lor and IuAher a�rees to removs same upon notice Irom fhe <br /> Approvad lor 06 ructlo Dete City en to replace bllc property da aped thereby. <br /> � � `/��.'�i�✓!�� � �/9� <br /> FINAI INSPECTION Dale <br /> Approved ee Conet�ucted Slpn re of Applicant Dete <br /> � PUBLIC WORK9 DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MU8T BE STARTED WITNIN <br /> 3200Ceds�Slroe1 1B0 DAVS OF DATE PERMIT IS ISSUED AND 1HEREAFTER IS i0 <br /> EverotL WA BB20� 8E DILIOENTLV PURSUED TO COMPLETION.THI9 PERMIT MAV BE <br /> Phona:269�8810 CANCELLED BY TME CITY UPON ANY STOPPAOE OF WORK ON TMIB <br /> PROJECT OVER 90 DAYS DURATION. <br />