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Date�Q.2slL c�� <br /> v„ox�wo.w.p�A,mj�i. <br /> Apphcation for n�ne �en� • {� _��� <br /> PUBLIC WORKS PERMIT �������W������P -- <br /> iolal Pee a_ <br /> �rss Auo� �ee Pein S_ <br /> Print or Type Only ee�.�«o�� s _ _ <br /> �11k�� �C(If� lydl �D'��S'�- ll ��4�lY'�.� ----_ <br /> Owne� MsihngAddress City Z�p Phone <br /> U�s�a m�. G� . ►�o � �n �.�r�� - ��-�ts� <br /> Applicant Mailing Address i�ty ��� Zip Phone <br /> Describe Proposed Work iCY��I /��[ _ <br /> Prolect Addreas(il known) � � _ � <br /> Attech lour�4� copias of plans lor proposed work• Draw to sCale and note Ihe lollowing es epoliceble�. � <br /> • Prope�ty Linas • Cenlerline ol slraet � <br /> • Oulline end dimensions of ell existing nnd • Indicate Nor�h <br /> proposed slructures on the lol • Show any proposad greding changes <br /> • Enisting and proposed ulllities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cans lor in9pection shall be made 24 hrs. in edvance� phone 25Q•88�S. � <br /> 2. All work shell be perlo�med In eccordence with Ihis pormit end currenl City ol Everetl Design nnd Construcllon <br /> Slendcrds and Spetificetlon9. <br /> 3. Cell Localion Underground Servlce 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•$555. � <br /> �!"� YE'L�(1�12r�:D � <br /> - ��� �1��'' G:�.� 7 � <br /> . � <br /> d <br /> a <br /> ACKNOWIEDGEMENT OF CONLITIONS <br /> The undersignrd owner/npplicent hereby egrees to holC and save herm- <br /> - less the Gry ol EverAt� Irom eny end all claims fo� dameyes, r,osis. <br /> erpenses, or causas ol aclion �hel mey erise 6ecause of inslallafion <br /> nnA meintenance o� Ihe improvement or o�her righbobway use hereto <br /> e�phed lor nnd further ngrces tu remove seme upon notir.e Irom the <br /> Approved for Construction Dale Cily and to replace pubhc propc�rry damn�eA IhereUy <br /> FINAL INSPECTION Date __ <br /> Approved es Cons�r�r,led Siqnature o�Apphr,ant Da�e <br /> rvPret� PUBLIC W.7RKS OEPNRTMENT WOfiK AUTHORIZED BV THIS PERMIT MUST BE STARTEC WITHIN <br /> � 3200 Ceiar Streel 180 DAYS OF DATE PERMIT IS IS£UED AND THEFEAFTEP IS TO <br /> Everetl. WA 98201 BE DILIGENTLV PUGiSUFD TJ COMPLETION. iHIS PERMIT MAV BF <br /> Phr,nn 259�p9+5 CANCELLED BYTHE CI7V UPON ANV STOPPAGE O�WORKON THIS <br /> PHOJFCi OVCI70C DItY: DURATION <br />