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Date�� 3 0„��,�w�,..�.,m��. <br /> Applicetlon Por ertp ono� • <br /> PUBLIC WORKS PERMIT °°°;�:�,:«° . <br /> ,�...00 ��.o.,e s <br /> 6a��ceDue � <br /> Print or Type Only <br /> PQ/�uc� N O���r� ce �NT�IK�lV����� � �v�n.�/ 9��� 3 �� L�<3 <br /> Owner Mailing Address City Z�p P�one <br /> (oPo,Mi��s •�ni 2-9d3 -�oY�f SE �o�t?�7�` >��� 33 � JS1.Y <br /> APO���ant MaJinBAddress City Zlp Phone <br /> Descnbe ProposeC Work r�.4 Ty7' b U 1 IZ �'4 a H i � �R� / U2 /�il/t/CCI(1 <br /> n W <br /> Pro�ect AEtlres61i1 hnown) `/ 3�� � �'1'�B 4� � <br /> Alle[h low�4�coO�M ol O�ans fo�Oropo5e0 w�mk�Draw Io bcale ane n0ie I�e lollowing as appLcab�e � <br /> •Praperly Line4 •Centetllne ol slreet /� <br /> •Ouiline an.l0im«nsions ol all e.isiwg antl •Ina�cale Narth V� <br /> pr000se0 stmdwes on the lot •$bOw 2ny pmpOSRe g�atlmg changes <br /> •E.�istinp and proposeG ulifnies •S�ow measuremenis M <br /> W <br /> 00 NOT WRITE BELOW TMIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cans Ior insneclion snall be made 2a hrs.In a0vance�vhone 259-8810. � <br /> 2.qil wmk s�all be pedorme0 in acwrdance with ihis pennil and cunenl Cil�ol Everett Design antl Construclion <br /> Stantlards and Speciliwtions. <br /> 9CaIILocalionUntlergroundService48hrs.beforeyouAlgTOLLFREENUMBERI•800�424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLFDGCMLNi OF CON�ITIONS <br /> Thr unaersiq�etl owne VnOPLcant itme�y agrees U hold ana sav¢harm� <br /> ---- - IP55 �hC Gly OI [V2fPI� ��ORI 8Oy dllD 211 CIBITS 10f QBIIi9qP5, CO515. <br /> e.penses. or ceoses ol action I�at may anse because ol ins�aVabon <br /> and ma�ntena�ce ol Ihe imorovement or other ugM�o4wey use�ereto <br /> apube0 br and luriher agrees to remove same upon noLce Irom��e <br /> ApPrOveE lo�Con6buC�iOn Date C�ly an0 to replace pubbc property damaBea thereby. <br /> FlNFL INSPEGTION Dale <br /> AppiOVCE BS COOS��u�iPE S�g�a�ure ol App6cani �a�� <br /> � PUBLIC WORNSOEPhRTMENT WORH AUTH0�I2E� BY TMIS PERMIT MUST BG STARTED WITHIN <br /> 3POOCeCerSbeel 1B0 DAVS OF OATE PERMiT IS ISSUED ..ND THEFEAFTER IS TO <br /> Everetl.R'A98Y01 BE DIIIGENTLV PURSUE010 LOMPLETIpN TRIS PERMIT MAY BE <br /> P�ona�.259�8810 CANCELLED 9Y TNE CITY UPON ANY STOPPAGE OF WORN ON iHIS <br /> PROJECT OVER 90 DAVS DURR710N. <br />