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Date_1iI� r��o-�Kwe�k.Pmmn. ,- <br /> Appliwt¢.�n For e�ny oeo� • <br /> PUBLIC WURKS PERMIT ���°��w°.�.°�^ <br /> ,a,��R� S- - <br /> � ..,.:�: ,>���.�, s - - -- <br /> � -'-_ -. s -- -- <br /> PriM or Type Onry - - - - -- -- -- <br /> A. G �-I�ir� � � o� <'e�l h► � �i,�r�=�f- <��,���i___��� :-,�-e.��� <br />� pwner Mailing Atltlres5 Cily ::p F'hr,nr <br />� N `� _ _ . _—.. <br /> Apphcant Ma�l�ng Address Gty Lp Phn��,��. <br /> Descnbe Proposed Work �����k?��J�`Jl�Q��� /�O/�Ji . . <br /> III _ I 7 <br /> W <br /> Prolecl AAtlress(if knownl b1 �� � <br /> Atfach tour 14�c�p�es ol plans lor proposed work� Drew lo scale and neM.'lhr_ lollowing as appGcabin � <br /> • Prppeny LineS • Cenlefllne o1 E�reel � <br />� • Outl�ne an0 dimensions of all eKrehng and • Indicate Nor�h <br /> pronosed structures o�Ihe lol • Show any proposed grading char�a��s <br /> • E*�sl��y ana propo<eA util�tieri • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.A�I calls for inspaclion shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.A�I woik shall be peAormed in acwrdance with Ihis permit and current City of Evereit Design and Constructinn <br /> Standards and Specifications. <br /> 3.Call Locafion Undergroun�l Service 48 hrs.before you diy.TOLL FREE NUMBER 1•800-424•5555. � <br />� � �� ��C� �� _ , �-�� � O <br /> � � /�d�� � I�y �� :� �- <br /> /�✓ LJ � � � � <br /> / I <br /> -�G`� , O <br /> 4 � i _ a <br />'i __, <br /> -�CKt�G1VL[DG!_haENT O�C[�NDITiONS <br /> ihe undersigned owncr/appLcanl hcreby aGrgeSlo hol�;end Save harm� <br /> less ihe City o1 Everett Irom any and all claims lor dama(��s, costs <br /> expenses. or Causes o� action that may anse becaose ol instau���o�i <br /> and maintenance ol ihe improvement or olher nqM-oFv�ay �sr• heielo <br /> appi�ed fer and I�rther ag�ees to remove same ❑po� n�,bc�� ��om the <br /> Approved lor Gon5lruCtion DatO City and to replace pubhc properiy damaged �hereby <br /> FlNAL INSPECTION DOte <br /> Approved as Const�ucled Signature ol ppplicanl ������ <br /> Pv��rrtt PUBLICWORKSDEPARTMENT WORK AUTHOFIZED BY 7HIS PERMIT MUST 8E STA9TL� WI7HiN <br /> � 3200CedarStreet 100 DAVS OF DATE ?[RMIT IS ISSUED AND THENEAFTER �S TO <br /> Everetl,WA9B201 BE DILIGENTLY Pt1R5UflD TO COMPLF110N. THIS PEF'iA41T MAV 8f <br /> Phone:259�BB/0 CANCELLED BY TH[ CITY UFON ANV S70PPAG[OF WO�� "N ?�i�5 <br /> PROJECT OVER 90 bAYS l�U�ih.ilON <br />