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Date ," �� � ✓ <br /> c„ni��wnn.v.,m,i. 8G— ��� <br /> • - Application FOr ei�p oent • _ <br /> PUBLIC WORKS PERMIT P�°;o„F;;`� � — <br /> LeN�ppl Feb Pn�� S <br /> Print or 7ype Only a.�.��.n�. t <br /> O�✓�� <br /> /' /��4• ////'!il't:�'S/1i� �/r% /lCI�J SYSf ft'Y'�!(� `/���D �`�`I"3795 <br /> Ownar MaU�ng Atldress City Zlp Phone <br /> ��'' ''' c �1:29—/��ih s� sr' �'�,�f�•,�- Il9�'o ��7-�f9.s <br /> A phtanl Mailing Address Gty Zip Phpne <br /> Oescrlhe Proposed Work C"l/!)�/�r/'P['l4�S [/llilZ�� QQ' .Si'lY /�AN _ <br /> Prolacl Address lil knovml —�y�q- /001/, CT. S,� � <br /> Mtach lom(41 cop�es ol plans foi prapasr.d work� Drew to scale nnd imte Ihe lollowing as appGceblr.� � <br /> • Properly Linas • Conlerline ol streel � <br /> • Jutlme and dimenaions ol all e.isung nnd • Indir,ele N�rih <br /> prcposed slruclure5 on Ihe lol • Show eny proposetl�- ndiny chPnges <br /> • Exlsting anA proposad utilities • Show meesurement � <br /> DO NO7 WHI7E B[LOW THIS LWE <br /> PERMIT CONDITIONS � <br /> 1 All ca�ls lor in5peclion sha:l be made 24 hrs in advanr.e� phone 259•8815. � <br /> 2 All work 4hell be perlormed in aCCOrAence wdh Ihis Fermi� nnd current Cily of Everell Des�qn antl Conslruct�rn <br /> Stantlerds end Specilicetions. <br /> 3 Call Lor,Ttion Undergiound Service 48 hrs bafore you dig TOLL FREE NUMBEH 1•800•424•5555. � <br /> 5�� 9�c�A T� �L' CfFry.cFo �,�� T'NE.�/ O <br /> , �LG�L� A�%�.,C J'p�L H�c+AC. J i S �:� <br /> . H <br /> � <br /> OB/15/86 11�47Wf OOORN149T � <br /> � a <br /> DPT.10 f25.00 <br /> cr� s�s.00 <br /> ACKNOWLEDGFMENT OF CONDITIONS <br /> __ _ __ The untlersigned uwner/apPlicent hereby agrees lo ho�d end snve ha�m- <br /> less Ihe City of E��erett Irom eny end all cleims lor demages, r.osis. <br /> eMpenses, or couses ol ection that mey enae ber,euse ol instailation <br />� `� � � r� s�S�� entl mamtenence ol Ihe improvement or olher �.�hPof�way use he•elo <br /> _" �2 �' C applied lor end furlher e �ees to remova aemn u on nohce Irom Ihe <br /> Approve f onslruc�ion �e�e Cily ond to�eplece pubGogproparty demaged thereby. <br /> �Q- � 3 i !n� .� <br /> FINAL INSPECTION i Dete <br /> APP�cved Ts Consiru Slgnalure ol Ap hcanl Date <br /> rvrrel� PUBLIC WORKS DEPAiiTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Ceder Street 1B0 DAVS OF DATE PERMIT IS ISSUEC AND iH[REAFTER IS TO <br /> Evere1L WA 9A201 BE DIIIGENTLV PURSUED TO COMPLEIION. THIS PERIu11T MAY BE <br /> Phone 259�881 5 CANCELLED 8V THE CITY UPON ANV STOPPAGE OF WURK ON THIS <br /> IPFOJECT OVER 90 DAYS DURATION. <br /> L <br />