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Date i � '�r-�D <br />apn��calion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />-e � <br />oW�e� <br />SGiir� e— <br />AppliGenl <br />Descnbr, Propraed Work <br />' //'� ~' S�S� <br />Mailinq Address <br />—7/�/�2'— / /T �•.. Iri�vt/ v <br />Pro�ecl Address lil known� <br />. <br />� 2 ./ <br />Put��2 Wortf PnrmA n '� -- <br />A�an Den� • - <br />PubncWahafee 6 <br />ro,�„�. <br />lnee�oo� �nePe�O S Q` — <br />Baiqnce Oux s � <br />— �� Zip Phone <br />G� f in4� fI/X+ �� X 4'��. _ <br />1� -^�� R? O '�/�.GL�sa—a/a� = <br />�J ' <br />JI SE __ <br />Attach fou� 141 copies ol plqns for proposed work � Draw lo scale flnd no�P.�Gen'terline of tPeel a1'1e <br />• Property Lmes • InAicate North <br />i Oulline and dimensWns of ali evisimq anA � Show any proposeA grnCin9 chane�es <br />proposed siructures on the lot � ghow measuremenls <br />• Existing and proposed ulilities <br />PERMIT CONDITIONS <br />1. Atl cells lor Inspection shell be made 24 hrs. in advance - phone 259•8810. <br />2. 411 work ahell be perlormed in eccordance wllh this pern d and wrrent Ciry ol Everett Design and Conshuclion <br />Standards end Specilicetions. <br />3. Cell Lor.xtinn Underground Service 4B hrs. Uelore you dig. TOLL FREE NUMPER 1•800•424•555 . <br />� GI'P�1 2�f+'nN5 o1'"T1oN TO 2��'�QE �r��a��T To <br />MCK�' cc>i.T1'���T�t'Y� 'f� t�fL�v� PRaPE.�-y''f fvt- �� <br />r��. <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEUGCMENi OF CONDITIONS <br />1hu undeisi9noA owneVapP�ir.anl hereby eg�Res lo hnitl and save hnrm- <br />less Ihe City o� Everetl Irom eny anA all claims fo� damayes, cosls <br />eepeoees. o� cau5e5 0l aclion Ihal may �IISP. hP,L2U5¢ o� installaho�� <br />anA mainten�nce ol �hF imP�a°eme.nt or other nght�ol�way use hF!reto <br />a��i�ed io� and lurihe� a9iees lo �e���ove seme uPon noUr.e trom Ihe <br />CitY �nA �O replir.e pU�hC PropP,�j da��,a9eA Ihereby. <br />^PVPfP�I PUBUCWORKSOEPARTMENT <br />� 3200 Geder Street <br />Everetl. WA 9B201 <br />Phone:259�8B10 <br />Si �ure ui �iq,��.,�,�„ ... <br />yy K AUT Of71::ED BY THIS FERMIi MUST BE STARTED WITHIN <br />BE DIDLIGENTL� ��'URSIE[D TOIGOMPLETION�THIS PERMIT MAV BE <br />ChNCELLED BY THE CIfV UPON ANY STOPPPGF. OF WORK ON THIS <br />PROJEC f OVER 90 DAYS DURAiION <br />