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Date�o��/� <br />� Apbhcati�n For <br />WOqKS <br />I <br />PUBLIC <br />Pr(nt or Type Only <br />Describe Proposed Work <br />Project ACdreas III known) <br />� <br />, TO POSTIN <br />�RMIT <br />� 88 <br />� �� <br />M1 _ N N <br />Address <br />/� PiN4c Vlo�h� Perm�l � d'9_ �� <br />,�, o.,,, . _ <br />PuohcWor��Fea —�--- <br />fotelfee i_ <br />leu�npi innPem � <br />Beience0�v ���� <br />a- <br />002 -3z Z - yo -a�o- is-e.�� <br />Gp <br />Attech lour (4) coples ol plens for proRosed woik - Draw to scale antl noln Ih� lollowing os applicable: <br />• Property Lines <br />� Outline end dlmenaione ol ell exishng and <br />proposBd slructuras On Ihe lol <br />• Exlsting and proposed utlGtlea <br />• Cenle�line ol atreet <br />• Indicefe Norih <br />• Show eny proppyed grndinp changes <br />• Show measuremenle <br />S ,T�S'c, <br />PERMIT CONDITIONS <br />1. All calle for Inapectlon al�all be mede 24 h�e. in advance • phane 259•8810. <br />2. All work ehall be peAo�med In ecco�dence with thla permit end curcent Clty o1 Everell Desipn end Conatructlon <br />Stenderde end 3pecificatlons <br />3. Call Locallon Undeipround Servlce 48 his. belore you dlg. TOLL FREE NUMBER 1•800�424•5555. <br />� S �� �7'%CL"///J'� <br />�tJ/i`= ic �G� //ll�S'�� i� � T� <br />�',�''vcr�iv � C'�T.�'�L •�. j�'�%E�-%�c=�r/xt� <br />�,�i o s2 Tv �'�nJ TisJ�.F o�" Fi� < <br />� //���ff'dA"i�Pc <br />�<,��s- �.P-��, <br />Approved as Consiruclad <br />everPtt PUBUC W01iKS DEPARTMENT <br />� 3200 Ceder Slreat <br />Everelt, WA 98201 <br />Phone:259•B810 <br />w'T� fs��a�'r�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />I, <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to ho�d antl seve �arm• <br />less Ihe Cily of Evere�l from any and all claims lo� damagea, coate, <br />e■ponses. or causes ol ection thaf may erise bocauso ol installetlon <br />en ainlennnce ol Ihe improvemenl or nlher righl•obwey usn he�eto <br />a pli d lor and lurther agrees to iomove same up;n notice Irom Ihe <br />il �and to replace public property dameged Ihereby. <br />5ignalure ol �hcanf � — Da e <br />WORK AUTHORIZED 9Y THIS PEHMIi MUST BE STARTED WIIHIN <br />1B0 DAYS OF DATE PERMIi IS ISSUEO AND THEREAFTER IS TO <br />BE OILIGENTLY PUFSUED TO CGMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE Of WORK ON iH15 <br />PROJECT OVER 90 DAVS DURATION. <br />