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/1 �/J�y'�FCG <br /> DH�e��7�L,Q (J Pubuc Wo��s P rmi <br /> Applleetlon For ema o+n� .��. <br /> PUBLIC WORKS PERMIT Pu�ToulFe:`°° . - - <br /> Lee�Appl ian PUU � __ <br /> Print or Type Only B�i�nceDue S _ <br /> �l-�L� �,� �r�h �rJ <br /> Ownar M Iling Add�esa City Zip Phone <br /> Appllcant Melling Address City Zip Phone <br /> Deecribe F'ropoeed Work l TI�V"�A�r � 1JI�! � <br /> Projecl Addrene(il known) _ �� , �i^�A _��_ � <br /> Attech lour 14) copiee ol plene lor pro0oead work� Diew to acele end nole the lollowing es epplicehle: � <br /> • Property Linee • Can�erline ol st�eet � <br /> • Outllne and dimanelons of all e�isting entl � Indicate North <br /> propoeed elructurea an the lot • Shaw any proposed gratling changes <br /> � Exieting en0 propoeed utllities � Show meesuramenis � <br /> DO NO7 WHITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All celle lor Inepacllon ehall be mede 24 hra.In.,dvence•phona 259•8810. � <br /> 2.All wo�k ehell be peAormed In eccordance with thle permlf end current Cily ol Eve�att Deaipn and Conelructlon <br /> 9tenderde end Specificatfone. <br /> 3.Cell Locellon Undaiground Servlca 4B hrs.he2�e you dip.TOLL FREE NUMBER 1-800�424•5685. � <br /> (1G» '�lV'�'-1� � <br /> c���2aB8 � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicant hereby egrees lo holtl Bnd seve herm� <br /> less Ihe Clly ol Everett Irom any a�tl all tlaims lor demegas, coats. <br /> eMpenses. or ceuaes ol eclion Ihal may erise beceuee ol lastelletion <br /> end malnlenance of ihe impiovame� t nr olher nght-ol-wey use hereto <br /> Approved lor Conslructlon Dete applied lor and lurthe� agrees to n move same upon nolice irom Ihe <br /> City end lo replace pub6c property r.�maged Ihereby <br /> FINAL INSPECTION Date <br /> Approvetl es Conetructed Signetura ol AppGcanl Oale <br /> evrrrtt FUBLIC WORKSDEPARTMENT WORK AUTHORIZED BV THIS PERMI'' MUST BE STARTED WITHIN <br /> � 3200CederStieel 180 DAVS OF DATf PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt.WA 88201 BE DILIGENTLV PUFlSUED TO COMPLETION THIS PERMIT MAV BE <br /> Phonr.259�8810 CANCELLED BV THE CITV UPON ANV ETOPPACiE OF WORK ON TNIS <br /> PROJECT OVER 90 DAVS DURATiON <br />