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� �-�� <br /> Date � „-�,�wo,..g, <br /> hpplicaiicn For `i�a Dec� • �• - <br /> H <br /> P�IBLIC WORKS PE�MiT ��°,orFeeFeQ 5 _ <br /> ,y"'..C'+] .�sseaoiceeva�a5 __._. <br /> m�� P��.rTppeOnly TO POSTING C-�s-5s �a1dnCeo�. 5 _— <br /> aycn � �/�}Q� <br /> y z� �� � ) i'�Yl')��l'� C-C��� q�v�n� o��-��S'�� <br /> � y,��-7, Owner �da��ngAtl�ress Cay Zip Phone <br /> O x0 ` <br /> � v'r 1 �(_J_t ri �� {cc� � �'-F�.�J ���� �II_� i' <br /> yZr APPlican� �dadinyAdtln...'— __ - _ --_ . - •v��on�, '---' <br /> n o�i <br /> H C7 � . <br /> � � � ���� <br /> �7 �C7 Descrihe Proposed Work __ . ---- .- - - _-.— --_ ..--- —_.--.. _ <br /> O <br /> '7� O <br /> 9 H� _. . -- <br /> r ~y - � <br /> � <br /> H �� I 1�2."?rY.�i'' -- � <br /> O C7 f/� P�olect Addross Uf knownl � <br /> � �t" ;,vach lo�,r i4� �opies ol Dlans lor proposed wo�k��rar. io scaie antl note Ihe lollowing as applici�hi� s <br /> �:� [rJ <br /> 2, H V1 • Property Lnes • Cenlnrline ol sbeni � <br /> y �� • Ouiline and dimensions ol an r, •.nnq an�l • Ind�cate No�ih <br /> prOpoSEtl S�ruCIufES On�hc lol • $��ow any prppo5��1 i)r:i[1my �:hangos <br /> • Ex�stin� antl proposn_d ubhLes • Shn;v nv.,�surements � <br /> DO NOT VJRITF BELOW ?HIS LINE <br /> PERMIT CGNDITIONS O <br /> 1.All calls lor inspection shall 6e made 24 hrs.in ativance�uhune 259-8E10 � <br /> '� � 2.All work shall be pedormed in ac[ordance with this permil antl current Gty of C�.moH U�.c:.un and Construchon <br /> ,,.�,, �� Standards and Specifir„itions. <br /> 3 Call Location Untleq��c•.in:l S��i:"r��an t.r; ��,�for��y^u r!i�t TOLL FREE NUMBER 1•800•424•$$$$. � <br /> � �Y' � <br /> � ' � L� �-L T.�, <br /> �,;,._a C�L1z-iti�i-Z– c_�_ � <br /> �—• .��yt�f,`�(�,u� � <br /> ��_! � <br /> ` —"� ``i 0. <br /> L <br /> e .:� <br /> hCKNOWLLDGEtdENI OF COYDiTIONS <br /> �� _ The u�dersigned owncr/npplican�hcrehy agrees to hald antl save hann- <br /> — Iess Ihe City ol Everetl Irom any and atl claims tor daniages. co;ts. <br /> eKpenses. or causes ol �clion thal may arise because ol uislallation <br /> and ma�nlanance ol Oie improvement or othcr riqhbot�wny usr herelo <br /> - applied lor antl lurther agrees lo remove same upon nohce irom Iho <br /> hnP�oved lor Conslruc�ion Date City 2nd lo ieplace public property damagetl Iheret�y <br /> PINAL INSPECTION Date <br /> l.pproved as Conslructetl Sic,7n;tlme ol Applicant D:ve <br /> rvr�e:t PUBLICWORKSDEPARTMEN7 P10RN AUTHORIZED BY THIS PBHM�i MUST BE STARTED WITHIN <br /> � 3200CetlarStrrrt 180 DAYS OF DATE PERMIT IS ISSUED AND THGREAFTER IS TO <br /> [veret6 WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY L"- <br /> Phone-259�eFl10 CANCELLED 6�'1HE CITY UPON AN1'STOPPA(l[OF WOF.V<ON i1115 <br /> PR(;JECT OVER�o �AYS DURATION. <br /> _ _ _ , <br />