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� � <br /> ��� � <br /> ��� ----- -- ---- � <br /> � <br /> ��� Date � jd 9/ r»� + <br /> rve�c wen�vnm'a/• <br /> Vj� AGPIiCatlon FOr 9ba D•m . S�� P 9y1/ — J�`/1,('— , <br /> �� PUBLIC WORKS PERMIT ���Kw�-••�•� <br /> �o�.��.. s_— <br /> �HO�y ��a�eooi Fw o�q S '� <br /> �i[�a O Print or 7ype Only '•'•^°•o�• ' <br /> 45• O I <br /> � I <br /> �y �' . <br /> H /,l�i� ._--„ -�o .�003 l/ G�a-d.-,�. /�,¢ �„� 5 P/t y ? ya-a�o P � <br /> �}G7 H Ownar MaiNng Address Ciry Zip P�one �I <br /> ��y <br /> �� AppliCant M�ilinq AOCrese Clly Zip �hone <br /> y � <br /> Deecrlba Propoeed Work � AiL_���-- �'�, <br /> Prolect Atltlrese pl known� � Yf 1 s 3 Yr 7i 3 S/f= t P o y�,� 3�7 w �/T ' /9 � �� <br /> Anech lour(a)coples o�plene lor proowetl work-Draw to scale antl note Ihe tollowinp 9e npplicable: � � <br /> • Vroperty Lines • Cenlerline ol sireel � <br /> • Outlli,e and dimenelonn of afl exfstinq end • intlicele North <br /> propaeed et�ucturoe on t�e lot • S�ow eny propoeeJ qrading c�enqes � <br /> • EaleUnp enE O�opoled u1111ties � • Show meaeuremenle � �� <br /> DO NOT WRITE BELOW 7HIS LINE O <br /> ' ' PERMIT CONOtTIONS <br /> t ' 1.All calle lo�Inepectlon shall ba meda 24 hrs.in advance•phone 259•8810. � <br /> � 2.All woAc ahell be peAormed in eccordanca with Ihle parmd and cunanl Ciry cl Everett Desiqn anG Conatructlon <br /> '�1 Standarde and Specilicati�,�nn. <br /> 3.Call Locatlon Underpround Service 48 hra befare you dip.TOLL FREE NUMBER 1-800-4245555. � <br /> '�' <br /> /� / O' ' f �%��x.G.' 4/01�h- �'�t.n,.�(� :�"�+1��La-Ci<:iF i <br /> 1_I � , �, <br /> 1 '��° �?' (f� <br /> 1- <br /> _ O <br /> -� a <br /> -, , <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br /> L ' The untlersigned ownBqappllcBnt heroby eg�9ea to hold anC save�arm• i <br /> leee I�e City ul Everelt from �ny anA all claims lor damepea coeta <br /> expenaes, or ceusee ol actian I�et may arl�e becauae at inatelletlon ' <br /> anC maintenance ol Ihe improvement ar other nghhohwey uee hereto 1 <br /> aDP��etl IOf antl Iufiher agreae to rlmove Seme uoan nalice Irum Ihe <br /> 4pproveC lor Conatruction Date Ci�y 3nd 10 IfP�0C0�uhliC plOpEfty tlemegeA fhefeby. <br /> I <br /> =1NAL INSPECTION Onte <br /> >pprovetl aa Conelfuctetl Signalure ol Applicant Dale <br /> PUBLICWORKSDEPARiMEN7 W�HK dUiHORIZED 9Y Th!IS PERMIT MUST BE STAFTED WITHIN � <br /> J200CedarSlreel �80 DAYS OF DATE PERMI� I> ISSUED AND THEREAFTER IS TO � <br /> EverotL WA 982nt BE DILIGENTLY PURSUED TO COMPLETION. rH�S PERMIT MAY BE I <br /> P�one:25&8810 CANCEL:.ED BV THE CITY UPON ANY STOPPAGt OF WORK ON 7HIS j <br /> PROJECT OVER 90 DAYS DURA710N. i <br /> � <br />