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DateJ�" �1 <br /> Puo,r Warxs Vermit• ��— <br /> Applicalion for Hino o�oi • <br /> PU3LIC WORkS PE�MIT ruUtowFee��� : <br /> leee Aoo� Fea P��a s ._ <br /> Print or Type Only <br /> naiam:�n�i�. s <br /> r (�i�►�17�1 ly�j(. ' . � ci C,'3 �� � ��'��--_�.�(,�_ <br /> Ownor aiting qdtlress � <br /> ���� Gty Zq, Phone <br /> �'.�"1{��lll�l��( ,�,��' �l� �v�7iy1�,l l�'j1� �1�5�� ��S' n7�1 <br /> APpli<aN Mniling Add� �P��— "��� <br /> ���� Z�� Phone <br /> Dascribe Pn�posad Work . �'n�[�r'�' � g�-� <br /> Project Addresn�if known� �`I�� �hnT� / � <br /> Allech lour(4)copiea of plans for proposed work• Draw to scele qnd nole�he�ollowmg as applicable�. � <br /> • Property Lines • Cenlerline pf straet — <br /> • Oulline end dimensions of ell existing end , � <br /> proposed et�ucfures on Ihe lol � ��dicale �orfn <br /> • EMisting and proposed utih�las � Show any proposed grading changes <br /> • Show measuremants <br /> DO NOT WRITE BELOW THIS LINE � <br /> FERMIT CONDITIONS O <br /> 1. Aq cells lor Inspeclion ahell be maAe 24 hra. in advance- phone 259•881 5. <br /> 2. All v.�ork ehall be perfmmed In acr.ordence wlth ihis permil end cur�ent City o1 Evere�l Desiqn and Constructlon ' <br /> � Slenderde end Spaci�ications. <br /> 3. Cell Location Underground Service 4B hrs. belore you diy. iOLL FREE NUMBER 1•800•424•5555. <br /> / !/6'/_/L (��p�'cjCS / -8 ' �'7 � <br /> �,r�.,��.- Nnr�,f��. �� 0 <br /> Y J`'`� <br /> �" <br /> � <br /> 0 <br /> � <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby egrees lo hold and save ha�m- <br /> less Ihr, City ol Everetl from eny and all claims for demages, costs. <br /> expenses, or ceuses ol ection that mey erise because ol instellxtion <br /> end meintenance of the Improvement or olher nght-ol-way use hereto <br /> Approved for Conslruction Dele epP11e� �or and Iwthei egrees to remove aemn upon notice Irom Ihe <br /> City and to replar,e pu6lic property damagetl ihereby <br /> FINAL INSPECTION p��e <br /> Approvetl es Conslrucled <br /> SipnaWre of Apphcenl Date <br /> everett PUBLIC WORKS DEPARiMENT WOFK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 320G Cedar Streel 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Evr.retl, WA 98201 BE DILIGENTLV PURSUED TO COMPLEiION. THIS PERMIT MAY BE <br /> Phone�. 259-A815 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON TNIS <br /> PROJECT OVER 90 OAY� DURATION <br />