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-i/7 � �,_� <br /> �BtE� PuEllc 1Yorks Permll s /7S G Ud <br /> Applicat;on For Biap 000�.•.���� �Q�d <br /> PIJE�LIC WOfdKS PE6�MIT °°°4a,aFee��e S_ <br /> less Ao��Fae Vnid $ <br /> Balenco Duo S� <br /> Print or Type Only -- <br /> � <br /> ��;y��� �e� / �/��—�-� ��-,�' '�,-� —//� � <br /> pW�e� Mailing A� :ss City Zip Phone <br /> . ��`�Z i3 9�5�= � �'gz90 S6�� 9' 3`F� � <br /> Ap fcant Mailing Address City Zip Phone <br /> Describe Proposed Wor� / ` ` � �f�=1==��'�"Q-� ,�"' �L L"" "— ' "- � <br /> - 1-f N <br /> �9 K7 <br /> Prolect.4ddress�if known) ����7— E- /J:'d.c:i�-� //%Etd L��. � Q � <br /> � <br /> Attach focr(4)cooies of plans for proposed work-Dra�v to scale and note the lollowing as applicable: � `� <br /> • Property Lires • Centerline ol street � � <br /> • Ou�line and C�mensions ol all existing and • Indica�e Norih <br /> proposed sirur.twes or,the lot • Shuw any p�oposed grading changes H <br /> • Existing anA pronossc ulilities • Show meacuremenis � Z.� <br /> � DO NOT WRITE BELOW Th'iS!.INE O � y <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be mode 24 hrs. in advance-phone. 25J•HS�$. � M <br /> 2. All work=_hall be pedormeti in accordance with this permit and current City ol Everetl Design and Construction <br /> Standards and Speciticationa H <br /> 3. Call Locrition Underground Service 48 hrs. belore you di9.TOLL FREE NUMBER 1-800•424•5555. � N <br /> T, �),e.'i!-E�J�fy ACfESS Tn r,��s .�'ES�OEn.�IE To h'E O � <br /> TA,cEti CFf �•�ff� r1LGS�/ O.LL� � <br /> i <br /> � � <br /> o � <br /> a N <br /> � <br /> Hn <br /> I�7 <br /> ACKNOWLEDGEMENT OF CONnITIONS <br /> The undersigned mvnedapplicanl hereby agrees lo hold and save harm- <br /> less the City of Evere�l from any and all claims for damages, costs, <br /> �,�-S' e..penses, or causes of action that may ari;e because ol installation <br /> � �` �(�D��� and main�enance of �he improvemenl or othrr right-obway use hereto <br /> � �� �� npplied for and luriher agrees to remove same upon notice Irom �he <br /> .4pproved tor Construc;ion �a�e ity and to replace public property damaged thereby. <br /> �������'1 2 -�r ` 1 u-!.i^�2 , <br /> FINANfI�CTION Date � � � <br /> Approved as Constructed Si�nature ot Appliwal Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOriIZED BY THIS PERMIT MIIST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLE710N.THIS PERMIT MAv BE <br /> Evere�l,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br />