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�"' <br /> Date��� � vuli.r�vcn..�,.... . /� <br /> Hin9 DeG� . J�i. J 4�c7 ��--/ <br /> Aoplir,ation Ibr � <br /> PUBLIC WORKS PERMIT °�°�°°�°°,��`��. -� �_ <br /> ,.,�a���� 5- <br /> P„a�,�� F.�N.,� s_— <br /> o.,�.,�«o�� 5 <br /> Prinl or Type Only ---- <br /> [�7 t*1 � <br /> �ozayc Lon�lc� Gilell � .7i�iG� An. �rr��_, _��PiP/� 9d1_c/ «Sd- �/G�13 <br /> � y � Owner Mnihnq Atf�� Cay Z�p Phone <br /> H � r�-i Sa/y1J __.--_ — <br /> � y� ��PPlmani 1.laihnp Addn�ss GIY LP Phonc <br /> � V1H �, �� / f� <br /> Descnbc PrOposcd Wark �����e �z W� /`�Y� .�i rri�r-�jJh111l1�{�� �'�� <br /> � _ � '� - - <br /> � d <br /> OH <br /> H/� � g W <br /> M,Y (] / ,,l• �' / <br /> Z y � Proiect Atltlress UI hnownl � y l � ���f 4t�-/�e— — � <br /> � p-i y Atlach lom�A�copies ol plans lor proposed work� �rav:to 'scnie anA nole ine lollowin9 as apU�icabie'. � <br /> � • Property Lines • Centerlme oi street 'A <br /> H V� <br /> n b y • OutLne nnd tl�mensions ol all enstmg and • Intlicnte North <br /> 5'� � nroposetl sirucNres on Ihe loi • Show any proposed gmding changes <br /> ; • [xi5�ing and proPosed u�diUes • Show mca5urement5 M <br /> s ■ . ■ <br /> y A��i <br /> H O V! DO NOT\NRITE BELOW THIS LINE <br /> � PERMIT CONOITIONS � <br /> 1.All calls lor inspec�ion shall be made 24 hrs.in advance�phone 259•8810. �\ <br /> � 2.All work shall be pedormed in accortlance with this permil and current City of Everel�Design and Constmction ♦ <br /> � Slantlards and Specificaiions. <br /> I 3.Call Lowlion Untlerground Servicc A8 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �_' � <br /> , �? ' ' ' . % .. ' /: '.!� ' . _� . � <br /> I __ /�,. '[� t . . _ .. . . � . ' . , �.� . i _I <br /> �1 t O <br /> a <br /> __ <br /> � ACKNOWLEDG[h1LNT OF VONDITIONS <br /> iho undersup�ed ownedaUPlicnnl hereUy aqrees to hold and save hmnr <br /> ._1�' - Iess Ihe Cny ol Evciett Irom any and all Uaims br damages. cosis. <br /> ` expenses. or causes ol action that may anse �er�use of installation <br /> and mainienance o� �he improvemen( Or other righ4o4way use hcreto <br /> - .__— apphcA fOr end Iuriher agrees lo �emOVB 53me Upon noLce Irom Ihe <br /> qpproveA lor Construction �,���' Clty and to replace pu6hc propeity dama9ed Iherr.by. <br /> FINAL INSPECTION Datc — <br /> Approved asConstructed Swnatwe i 'AppGcant ��'�° <br /> WORK AU7HORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> cvcrett PUBLICWO(1KSDEPAR7MENT 780 DAVS OF DAT[ P[RA11T IS ISSUED AND THEREAFiER IS 70 <br /> � 3200 Cetlar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERAIIT MAV BE <br /> Everetl,WA 98201 CANCELL[D�Y THE CITY UPON ANY STOPPAGE OF WORK ON iHIS <br /> Phonc::5�3�8810 pROJECT OVER 00 �AVS DURATION <br />