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Detel�i'�"''I <br />applicahun Fo <br />PUBLIC WQRKS PERM�T <br />Print or Type Only <br />Adaresa <br />� <br />�1J-133 <br />, ,, , _,v�,.s,,,,,�,,, . � <br />� ,-� �. _ <br />It'iJ �nll � 11 <br />PuM�c Wo�Mt ixa ' <br />lol�� Po� <br />' e�� �nul F�� PUE S � <br />Balmce Due i ZU - <br />`f . � %- /X� � <br />, �APPlfcenl MaHlnpAtldre66 Clty 21p Phone <br />7 <br />Dencribe Propoead Worh �.�,1 l�� -- <br />Pro�ecf Addreee QI knownl —��� � �L 5 �� �L , .S, E�. _ __ <br />A1lech 'our (4) coptes of plane Icr ; rrpaaed work � O�aw to ecele end note the lollowinp es eppiicable� <br />� Property Llnee <br />• Oulline end dimane one ol ell exislina end <br />piopoaed ehuc�uret on Iha lo� <br />• EKietinp end propoaed utilHlea <br />� <br />ApPicved <br />• Centerllrte of atreet <br />• Indicete North <br />• Show eny proposetl g'edinp changes <br />• Show meeeuremenls <br />PERMIT COND�TInNS <br />1. All calle lot Inepeclion shell be made 24 hra In edvence � phone iS9•e8i 5 <br />2. All woik ehell be pei�ormeA In accordence wllh this Oermlt end current City of Everetl Oesign anA Construction <br />Ftenderde end Specllicetiuns. <br />3 WII Lor,atian Undarground Servlce 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />:'i,/a.�:'.F (�/»:'h�f{='.':i.a/ /i'.. i.i� iiY����/ T< � /-i.':�Uf <br />Approved as Constructed ` <br />evPrett PUBLIC WORKS� <br />� 3200 Ceder S�rea� <br />Everell, WA 98201 <br />Phone�. 259 BA15 <br />NT <br />ACKNOWLFDGEMENI OF CONDITIONS <br />The unaersrf)nea owneriA4l��cen1 he�eby egrqee lo hoid end eeve hBrm� <br />-" less the C�ly ol Eversll Irum eny and ell clalme lur dameyea, cosls, <br />CMp@0995. L! CBU90S OI flC�lOf1 11,8� II�PY 91118 bPCBU98 O� I(1S�EIIB�1011 <br />�. end meintenence of the improvemenl or other r�ght�o�-wny use harnto <br />__ applied br enA furt�er egreea lo remova same upon nnlice from the <br />Clty end lo raplece public property dameged Inereby <br />- ��--_�,� __--_��Z _ <br />Sign�ture ol Applicenl Dele <br />WORK AUTIiOR12ED BY THIS PERMIT MUST OE SIARTED WITHIN <br />1B0 DAVS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PUfiSUED TO COMPLETION, THIS PERMIT MAV BE <br />CANCELLED B� THE CITY UPt,N ANY STOPPAGE OF WORK ON THI9 <br />I PROJECT OVER 90 DAVS DURATI04 <br />