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Date_._� . r�d�-�7 1 <br />App6cahon For <br />PU��LIC WORKS PERMIT <br />Print or Type Only <br />>licant <br />Maihng <br />TO PnsTiNG I -� —x �_�___ <br />� <br />n�r�,� w,.�.�v�.,,,n �� S� <br />Pi�9 �eu� • _. � ���� <br />Pobbc Wnr�a � m '- � -- - . . . . . .. - . <br />louiFee s _ . <br />lesa �no� Fer P���t { �-.�p <br />Beienc�0�m S ��r _ <br />Pnone <br />DescnAc ProposeA Woi.. I Y,� ) r-�� ��� � — ._ <br />Project Addrese Iil knownl `Z3 �� �� 'S� SE _ <br />ANeCh four (4) copieg ol plens lor proposed wo�k • Draw to scnle end note Ihe lollowing es appl¢nhlr.� <br />• Property linea <br />� Outlir.• ird di�r;�,�.-rn. ol ell eeist�ng enA <br />propose0 ��rw ...�r• ov Ihe lol <br />• Exisling ena propcd:� utd�tles <br />• Centerline al stree� <br />• Indicete Norlh <br />• Sh�w nny proposeA g�aAing chenges <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All cells M� Inepection ehell be meda 24 hra. In edvence - phone 269•881 O. <br />2. All wo�k ehell be peCormed fn eccordence wllh thla permit and current City of Everell Deslpn end Conetructlon <br />Standarde and Specificetiona. <br />3. Cell Locatlor� Underground Service 48 hra. before you diA. TOLL FREE NUMBER 1•800�424•5555. <br />S� Lti� �-Kas�. <br />Approved ae Construcled ` <br />Pvrrrtt PUBLIC WOHNS DEPARTMENT <br />� 3200 Ceda� S�reel <br />Everelt, WA 98201 <br />Phone�.259�8810 <br />� �- � (.0 `T' <br />�, Data <br />i <br />_� /��, <br />Da� <br />ACKNOWIGOGEMENT OF COHDITIONS <br />W <br />� <br />� <br />The undersipned ownenqpplicfint hereby egrees lo hold end save harm� <br />lesa Ihe COy ol Eearotl irom eny xnd all cleims lor demagas. cosls. <br />erpenses. or ceuses of ection Iha� may niise becnuse ol inslallation <br />end mnintanence ol Ihe improvement or o�her riphl-ol�way �. ie here�o <br />epplied lor end furiher egrees lo removx enme upon noticr Irom the <br />Gry anA lo replace public p�opertY damageA thereby. <br />���� —c�--�_ � % <br />Sign.' Ap ican� De� <br />WC HORIZEU BV THIS PERMIT IAUST BE STARTED WITHIN <br />18 '1F DATE PEFMIT IS ISSUED AND THEFEAFTER IS TO <br />BE �.._ �LV PURSUED TO COMPLETION. THIS PEFMIf MAV BE <br />CANC'LLEp BV THE CIT� UPOIJ ANY STOPPAGE OF WORK ON THIS <br />PROJE�.T OVFR 9J DA�S DURATION <br />