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�et@��V PuUucWod�Par — /�� ^ <br /> Appllcation Far ama�oso��• OS <br /> PUBLIC WORKS PERMIT P��Tot�iee�ea s _ <br /> Leu�oo�iee Fua d� <br /> B�I�nn D�e { ��� <br /> Print or Type Only <br /> ��a ri^� =�� 1� �. ���SLi'Y')�� � P ��_ <br /> Owner Mall�np Adtlress City Lp Phone <br /> w� <br /> qpplicent Mailing Address City Zip Phone <br /> Deserfbe Propoeed Work �.11���� �`�-� � �'" `C - � J( ��I ' " � ' �v' "�A�� <br /> , W <br /> Pro�ect Addreas(il known) � � <br /> Attach(our(4)copiea ol plane lor propueed work• Draw to scale and note the following as epplicabte: � <br /> • PropeAy Llnee •Ceilerline ol street � <br /> • Outline and dimenalune of ell exlating and • Indicele North <br /> proDased etructures on Ihe lot • Show any proposed grading chengee <br /> • E�In11nB end propoaed utilitlee • Show measurementa � <br /> O NOT WRI ELOW THIS LINE O <br /> PERMIT CONDITION3 <br /> 1.All calls for inspectlon ehall be made 24 hrs.In advence•phone 259�8870. � <br /> 2.AI!work ehell be peAormed in eccordance with thls pnrmit and currenl Clty ol Everelt Oesipn and Conetru�tlan <br /> StandaM6 and Specllicallona. <br /> 3.Call Locatlon U�derpround Service 48 hra belore you dig.TOLL FREE NUMBER 1•800�4245555. � <br /> O <br /> � <br /> 03/15/90 3:OSPM OOOiiM0A71 � <br /> a0003oz�s O <br /> �T.� �.� a <br /> �� :�.� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignod owner/epplicant hereby egrees to hold end sevo harm• <br /> less Ihe Cily of Everelt Irom any and all clalms for damages. cosl& <br /> <-���/� ,�� �^//0 exP'�nses, or causea ol acllon that may erise because ol Installalion <br /> � end maintenence ol Ihe improvemenl or other riphPobwey use horeto <br /> �� app�ied lor and luriher agrees to remove eame upon no�ice Irom the <br /> �Approv lor C ns r tion Dale Cily and to replace public property dameged Ihereby. <br /> PE 10� � '/� z �(Da� '�'1�'`'11�1 \ wu1 - ��IS^^�O <br /> ApProved as Conatructed � Signalure ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITIi1N <br /> �BO DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarSireet BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evarel4 WA BB201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8910 PROJECT O'/ER 90 DAYS DURATION. <br /> 1 <br />