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Dete—�%� <br />Applir.etion For <br />PUBLIC WORKS ��RPAiT <br />Piint or'ype Only <br />�5�. �nC /70 <br />MBiVing Atldress <br />.SQ �»e <br />Appllcent Mxiling Addreee <br />Deecriba Pro�oerd Work � •� � • — <br />Gfy Zin <br />aomm wmx. Ps,mn • �/��/�� �/ <br />Biap OePI � f��1_.2j�=L— _-- <br />vum�c wen�. F.e <br />TaI�IF�e � <br />Leef �pPl Fea PUE � --�Ty�e�� <br />an��ncaDue i '��— <br />�9' <br />PhonF <br />�o,.�.� _ �.S-�--- -- -- <br />Prolect Add. .9s (ii known) �2O - �� �f � S� _---_.- <br />Altech Inur (41 cuplav ol plens lor proposed work � Draw lo scaW anu nole ihe �ollowing as eppllr,eble: <br />• Pro{+erty Llnes <br />• Oulline and dlmensions ol ell e�ie0ng and <br />proposed elructures on the :�t <br />• Erleling end proposed utllities <br />PEFMIT CONOITIO�S <br />• Centedine ol elreel <br />• Indi�ete Norih <br />• Show a�iy proposed gixding chenges <br />• Show measuremenls <br />1. All cnlls �or mspectlon shel� be maAe 24 hrs. in edvance � phone 259•8815 <br />2. All work shell be perlormed in accortlance with this permq e�d cwrem Cdy ol Everelt �esign nnd Corstruction <br />Stendards end Specilicatinne. <br />3. Cnll I_ocnlion Underground Servica 4B hrs. balore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />y E.ciSTi.c%s- S/L1E/t,NiiCS �%�E U.tIB.PO,tF�CI A�t/� �N iVl�c/ <br />�ONOiTiO�fI, T.✓E •A/�/'LiGAI/T /S .C'FCfUi�EU iv .PEp,Lp(� <br />/��f� S/DE/I�AG.f" %�.OmAf•f-� .�U.f'i.Vb �ON��.PvlTiv.tJ. <br />/ <br />5� ,P�X�i" j.�{/,�.W Sf�UG�/� A.PE TO ,HE %ibit�7 - L��rEO %J <br />EX/STiN(r �(/FB L.4�tdi,ciS, <br />� iQ,✓✓ G�ADiN(s � T.�✓E L07 /S To Q� DO,r/E Sv As <br />/ <br />NOT TO /MP�G7 TifF Sv.flpu•t/oA✓�s Lt�TT H/iTii' <br />�iliA� G�✓,e7F.e �Pl�i�/•O�i; <br />' ' .—_ _-- � - I <br />��� �� ,�/ ����+CCC���III <br />AppiovedlorC istruction ��P I <br />—__—Sl�� � �%—'3a�� � <br />FINAL INSPECT'ON Datc <br />ApproveA ns Conetruc�ed <br />t•vrn•11 PU81IC WORN50LPARiMENT <br />� J200 Gedei St�eel <br />Evere��, WA 9F:01 <br />Phnne:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />-03/l <br />w <br />� <br />_/ <br />� <br />O <br />� <br />� <br />O <br />a <br />The undr.rsigned ownenopplicTnt narpby agrees lo hold and save herm� <br />less the City of Everetl from any end all cleims lo� demepes, costs. <br />oxpengas. or conaes oi echon thnl may erise becawe ol instellati� i <br />anA mamtenance of the imp�ovrmenl o� olher right-ol�wey use I•.e., io <br />appLeA Im end luriher ngreea �o remove aeme upon no�iCe Iroin the <br />City and to replece publlc property demeged Ihereby. <br />i <br />�{-�" -�-�'—�-",�-�--i ,.e o a k� - <br />SiqnaWre ol ApphCen� Uate <br />WORK AUTNORIZFD BV THIS PERMIT MUST BE SThRTED WITHIN <br />1H0 DAVS OF IITTE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />5F DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAV BF <br />GINCELLED BY THE CITY UPON ANV STOPPPGE OF WOfii ON THIS <br />FROJFCT OVER 90 DAYS DURATION <br />