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C�te 9 �� � <br />Applicnlion For <br />PUBLIC WORKS PERMIT <br />Print ot' Type C'nly <br />S %�/ /�',., t ^ <br />owner <br />Applicant <br />�Aelling Addreae <br />�f <br />cur <br />City Zip <br />Public WerF� P�rw�t • ��— `/ � <br />B�Up Depl • <br />Punl¢ Wor`e F�a s <br />Tcb�Fes <br />Leu �p0� �ee P�ia i_ <br />Bei�nc� Due f _ <br />o?D ��— <br />��� <br />35 =s 7-�, <br />Deecribe Proposed Work ���A�e .s �drk�n/k C�� D i f%/Y['� A. ��,� L['/�'�3 ��/ <br />_1�ivG/s �i1R.f� [�,v gT� ��r at' - <br />Pro�ect Addresa lil knownl <br />Attech lour 141 coplea of plene lor propoaed wo•k � Draw to scele end note Ihe lollowing es appliceble <br />• Properry Lines • Centerflne ol strae� <br />• OWline end dimenalons ol all exieting end • Indicele North <br />p�opo9ed etrUctwes on the bf • Show eny p�oaoeed grediny change9 <br />• Ezieting end proposed utilltias • Show measur�amenta <br />PEHMIT CONDITIONS <br />1. All celle lor Inepeclion ahell ba meda 24 hrs. in edvance - phone 259$8i 5. <br />2. All work ehall be performed In eccordanca with ihia permlt end currenl City ol Everel! Design and Construclion <br />Stenderds end Specllicetione. <br />3. Cell Locetion Underpround Service 48 hra. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />5� 1�.e',v��dAy Tc� Be C'n,�s;,� �� �� ; Ev ,�<-, - c, r� <br />ST��%D9��U +�`3l'7, �A,�9CyE0� <br />,-i OLD Cu.c.'B ftc �D ��TE�: i u i3E ,� �.��-, � r/J An/,:) <br />�J.✓sr.s�cc�� Pl.e S��ro,�/ � j.7. <br />('iTr ST<'tiiJF'�'OS �%��Yf'('//f�� <br />lor <br />FINAL INSPECTION 1 \ � <br />ApproveA as Constructed v <br />pyp�p(� PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Sueet <br />Fvaretl. WA 98201 <br />Phonp 259�P915 <br />Dete <br />� <br />Of 7�/E <br />ACKNOWLEDG[MENTOFCONDITIONS <br />The widereigned Owner/eppliCanl harxby egreee �o hold and seve harm- <br />lese Iha Gty al Everett fram any end all cleims for demeges. coeta <br />eMpenses. o� causes of actlon Ihet mey erise bacausa ol Inelallallon <br />end meintanance of Ihe improvemenl or other right-ol�wey uae herelo <br />epplied for and lurther agrees to remove same upon notice hom ihe <br />City end lo replace public properry demeged thereby <br />�/ �%ic'�f � <br />S�g twe of AnP��cen� Date <br />WORK AUTHORI2ED BV THIS PERMIT MUST BE STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTEI> IS TO <br />BE DILIGENTI V PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PFOJFCT OVFR 90 DAVS DURATION <br />