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Date����� Pubhc Wmxs Fr�mn• <br /> Applicahon Fo� e�ae oep� • � ��t ._ <br /> PUBLIC WORKS PERMIT �ubl¢WarweF�e s -- <br /> Tol�l Fee <br /> Leea�00� Fee Pud S <br /> Print or Type Only Belence0ue s <br /> �"111 �I(�a^�I)�`�t=:1)f1 (�„��l II7�`�� �# ;atil ;� � I�I�L `r ��j�-� �'�1(u� ���—�297�, <br /> wner Meiling Addrese �City Zip Phone <br /> ��I�� <br /> Applicant Malling Address City Zlp Phone <br /> Describe Proposed Work �����(��� _ _ <br /> W <br /> � �Pro�ect Address pf known) <br /> Attach lour(4) r.opiea of plene for proposed work� Drew to ecele and note the followmg as epplicable: � <br /> • Properly Lines • Centerline ol streei � <br /> • O�tl'ne and tlimr.islons ol ell eMisting and • Indicete Norlh <br /> proposed atructivas on Ihe lot • Show eny proposed greding chenges <br /> • Eafs�lnp and prop sed ulllities i Show measurements � <br /> DO NOT WFITE BELOW'.MIS LINE O <br /> PERMIT CONDITIUNS <br /> 1. All cells lor Inspeclion shell be made 24 hre. in advence� phone 259•8815. � <br /> 2. All wo�k 9hell he perlormed in eccordance wllh Ihl9 parmil end cunenl Cily or Everetl Design xnd Consiructlon <br /> Stenderds and Spacllicetione. <br /> 3. Cell Loca�ion Underground Servica 4B hrs belore you dig. TOLL FREE NUMOER 1•BOO.O20-5555. � <br /> O <br /> �UBL /G tdo�,�s' f Erzh�� T .r/ar ,��jac..��n f`��- �47 � <br /> �i�� � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDI.'IONS <br /> The undersigned ownei/epplicant hereby ngrees lo holA and save hTrm- <br /> - — less thr. Cdy ol Everelt Irom eny end :�II cleims for dema9es, cosls. <br /> expenses. or causes ol action Itml miy erise because ol installnhon <br /> and mamtenance ol ihe imprpvemenl or other ripht-obway use hereto <br /> apphed lor end Wriher ngrees lo remove seme upon notice frum Ihe <br /> Approved for Constructlon Dnte City and to replace public prope��y dem�qed thereby. <br /> // <br /> fINAL INSPECTION Dete "�i�" i AS/ �"-`"� � <br /> qpproved es Constructed ` i n ure of pplicant Date <br /> pyYfP�i PUBIII;WORKS DEPARTMENT WORK AUTMORI2ED BV THIS PERMIT MUS7 BE STAFTED WITHIN <br /> � 3200 L�edar Slreel 180 DAVS OF DATE PE�iMIi IS ISSUED AND THEREAFTEP IS TO <br /> Evere�t. WA 9820+ BE DIUGENiLV PUFSUED TO COMPLETION THIS PF�7MIT MAV B6 <br /> Phon? 259�A815 CANCELLEO BY THE CITV UPON ANV 570PPAGE C1F WORK ON TNIS <br /> f`f70JFG1 UVER 90 DAVS DURATION. <br />