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�� <br />Dnte <br />Appllcetion For <br />PUBLIC WOFiKS F�ERM�T <br />Print or Type Only <br />Mellinp Addrase <br />Deecribe Propoead Work � 0 r%�� �� �*-� <br />Prolect Address �II knownl hU�3 ' <br />��V � <br />City Zip <br />Attech low (4) coplee ol plane for propoead work � Draw to acele and note the lollowing es applicebie: <br />� P�opehY Llnes <br />• Outline end dimenelone of sll a■leti��g and <br />propoeed elmcturee on the W� <br />• ErleNnp end propoeeA utilitine <br />PERMIi CONDITIONS <br />Puelle War4 P�rm • <br />a� o.a. �/3� <br />hene won. FN <br />To1�l iN � -- <br />Lu� �Dpf FN R E �_— <br />B�ynn Ou� { <br />• Centerlina ol sireel <br />• Indicete Norih <br />! �f�ow mry proposetl greding chnngrs <br />• Sho�M meaeurements <br />.�"7 <br />1. All celle lor Ine�acllon ehall ba mede 24 hre. In edvence • phone 259•881 5. <br />2. All work ehall be paAormed In ecco�dence wlth thie permA and cwrent Clty ol EvereU Deslqn and Construction <br />Stendarde en� Spacillcetlone <br />3. Cell Locetlon Underg•ound Service 4B hra. befora you dig. TOLL PREE NUMBER 7•800•424•5555. <br />, ����3`�;� �i` <br />Approved lor CanelrucUon Data <br />FINAL INSPECTION <br />Approved se Conelructed <br />e�r�etl PUPLIC WORKS f<PART'dENT <br />� 3200 Cedar Strect <br />Everetf. WA 9070" <br />Phone'259-BCIa <br />Dete <br />ACKNOWLEDGEMENi OF CONDITIONS <br />W <br />F- <br />� <br />The underalgnad owner/eppllcent hareby egrees to hold end seve he�m- <br />leas fha Ci�y ol Everetl Irom er�y entl ell clelme lor Cameges, coats, <br />axpensas, or ceuses ol ection t�et mey ariee becauae ol Inatellelion <br />end meintenfmce ol the Improvement or other ripht-a4wey uee herato <br />epplled (or end lurther epree5 lo remove 6ume upon nolice Irom the <br />City and to replece publlc propeiry demeped theraby. <br />Signature of Appllcenl Data <br />INORK AUTHORIZED BV THIS PERMIT MU57 BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br />BE �ILIGEN'LV PURSUED TO COMPLETION THIS PERMIT MAV BE <br />CANCELIED BV THE CITV UPON ANV STOPPAGE OF WORh ON THIS <br />PHWECT OVER 90 DAVS DURATION. <br />