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DatQ � Put•Ik WOM P�rmX• <br /> Application For eao.o•o�• <br /> PUBLIC WORKS PERMIT ^�aKW°^�F� <br /> .a.�F» s <br /> Uu A,.pt F��P�W S <br /> Print or Type Only e�wz.ow f <br /> ^'••• Zip Phone <br /> Owner Plan Ch�ck Nos B 42915 � <br /> 7►pplicat.D�t�: 12/07/93 SgP� <br /> Job 11ddr���i ZldB CRA►ip Ayg <br /> Own�r: NOUNT STHSL <br /> Applkent T�nant: :iD Phone <br /> D��c�of Work: P�IN6 <br /> Descrlbe Proposed Work _ �BUILD OVBRttANG — �T�A�ygD Tp a�CB <br /> � OFFICS SST JOB SST <br /> � 11PPROVBD FOR PSRMIT: D11T8_/_�� gy W . <br /> Pro1�t Addross(if known) � <br /> � Attec�four(4)copies of pl�n6 for proposed work- Draw to scale and note the followinp as applicable: � <br /> � • Property lines • Centedine of street � <br /> . • Outlins and dimenafons of all exiatinp end • Indicate North <br /> proposed structures on the lot • Show any proposed gredinq chenyes <br /> I • ExisNnq and proposed utllitiea • Show meaeurementa � <br /> ' DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITION3 O <br /> 1.All ulls for Inapsctlon ehell be made 24 hre.in�dvance•phone 269�881 O. � . <br /> 2.All work shdl be peAormed in eccord�ncs with thia permit and curront City of Everott Desipn end Constructlon <br /> Standerd��nd Spxific�tbna <br /> 3.GII Locatio�Underpround Service 48 hrn.beforo you dp.TOII FREE NUMBER 1-800�4246355. � <br /> . `v��� �� 0 <br /> , ���� �-�� � - � <br /> '� <br /> , `'f-1,� /Z/� 9 3 � <br /> � ( 0 <br /> a � <br /> � <br /> , <br /> , <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> . The undersigned owner/applicant hereby aproes to hold and sava hum- <br /> less the City of Everett trom any and all c!eima for damapes, cost& <br /> expeOles, Or C8u6BE Of 8C110� thAf 1118y !II!! becBu6e Of inBtAlllti00 <br /> and malntenance of the imOroveme�t or other right-of•way use heroto <br /> applied for and further aqrees to remove e�me upon notice Irom the <br /> Approvsd for Conetructlon Oate City and fo replace public property damaped thereby. <br /> FINAL INSPECTION Date <br /> ApproveC ae COnattucted Signature of Applicent Dete <br /> PUBLIC WOHKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> 3200CederStroet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everolt,WA BB201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:2b9•8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS OURATION. <br />