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�ate ia/24/9z <br />T 6-�8-,s <br />Applicatlon For _ <br />, PUBLIC WORKS,�PE��VId�STI <br />Print or Type Only <br />Norla�i Oorp <br />�. <br />�: ,� � ,, <br />� <br />� -; .. <br />7114 - 212th St SB �,' ➢ioodinville,t:, WA 98072 <br />Meiliny <br />..se �. Vny.. ,., <br />�� i�� �� <br />( � C� I�i [') _ <br />., f i .: 1� i. � �li <br />I't. r <br />CI � � I'J _ 1 (�i -( ] <br />�� i ._: l�' r�_ _x_ �„ � � , .. � ..� . , <br />De�cribe Propoaed Work Na�r�inuse fhuvin i nsl <br />Pro�sct Addross (tl known) <br />�e���Wo�,.�.�n.9-� oo ✓ <br />eiay o�o�.. 39091 <br />r�eiK won�� r.. <br />TOUI FM f <br />L��� �ppl FN AIO S �/� <br />B�luit� ��e i � � ii <br />Ovz -3azyoi/83/ <br />Attach four (4) copies ol plana for proposed work - Draw to scale and note tne (ollowing as applicable: <br />• Propsrty Linee • Centerline ol atreet <br />• Outline and dimsnsions of �II exintlnq and • Indicete North <br />propossd structures on tha lot • Show any propoaed prading chanpes <br />• Exl�tinp e�d propossd utllkies • Show meaaurementa <br />PERMR CONDITIONS <br />1. IUI plh for In�cYion ah�H be m�de 24 hre, in adwncs - phane 259�8810. <br />2. All wOrk �MII bs psAormed in accad�nce wlth thi� psrmit end current City of Everott Deslpn and Canstnictlpn <br />Shnd�rds �nd 3pecMicatbna. <br />3. GII Loatbn Underyround SeMcs '.< ":r• beforo you dip TOLL FREE NUMSE111-80o-4i4�db6b, <br />e <br />�< �, <br />lpprovetl aa Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ced�r StreN <br />EwroH, WA 98201 <br />P�ons: 269�8810 <br />�Date <br />� ' z8- SJ <br />Date <br />W <br />H <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/epplicant hereby apreea to hold and save harm• <br />less the City of Everett lrom any and all claims for damages, costs, <br />expensea or causes of action tAat may erise becauae of installation <br />and maintenance of the improvement or other riyht•of•way uae hereto <br />epplied for and furtl�er aprees to remove eame upon notice from the <br />City and to replace public pioperty damaped thereby. <br />SigT�ture oi Applicent Dete <br />WORK AUTHORIZED B ERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DA ERMiT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENT URSUED TO COMPLETION. THI5 PERMIT MAY BE <br />CANCELL BV THE CITI UPON ANY STOPPAOE OF WORK ON THIS <br />PROJECT OVER 90 OAY; DURATION. <br />