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oat��'3- S� <br />Application For <br />pUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposer! Work . <br />Prolec: :ddress (if knor. n) <br />Pu011t Wa�ks Permil s <br />Bldg. Dept. e _ <br />Public Wo..e Far <br />Tolal Feo s <br />Lese Appl Fae Peld S <br />Belance Due S <br />:� ��/ C'�'.d7F.� r'� �f.�P.�rr' i <br />Mailing Address Ciry � <br />Mailing Address City Zip <br />i <br />� ��/ i.,.l`�/,G fS3 2.L <br />A[IBCh i..R (4) COPIP.S O( plPnc fnr mm�ncod wnA . n� .,.� �......-i.. "' "" '�' <br />• 'roparty Line+ <br />• '^ �•'Iine and di <br />.,:,posed stru�� <br />• Exlsting end p <br />PERMIT CONC <br />t. All calls for i <br />2. All work sha <br />Standards n� <br />3. Call Locatioi <br />Approved for Construction <br />S�-��c�i <br />— <br />�� <br />��c�i,�� <br />/� / ` ��T— <br />o� �� <br />��/ ✓i �.v/� <br />�. FINAL INSPECTION <br />Approved as Constcucted <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />Date <br />'Inwinn ac =���:^_"- <br />/��//�`��! `�c <br />/�� i�-/ C� C,�� <br />3 �� 'S��'� �' <br />W <br />H <br />� <br />„ <br />• <br />H <br />� <br />0 <br />a <br />�r � �e harm• <br />C 5, costa <br />s, tallation <br />ri� _ .... ..y„��.,rwny use hereto <br />applied for and luriher agrees to remo��3 same uFon notice from tha <br />City and to replace public property dameged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED RV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO:ECT OVER 90 DAYS DURATION. <br />