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Date =��U <br />Application Foi <br />PUBLI�� WURKS PERMIT <br />Print or Type Only <br />Owner � Maihng <br />(D���ll/�,5 Y�Y:' �l �M�,��� <br />Applicant <br />Descri�e Proposed Work <br />Prolecl Addrr.ss (il known) �L�s— //Z � <br />Cny <br />A�tach fo�r �J� copies of Vlans �or proposed work - Draw to scnle antl nole ihe lollowing as apphcable. <br />• Properly Lines <br />• Outline and dimensions ol ell exisling and <br />proposed shuctures an the lol <br />• Ezlsting and proposed utildies <br />VULIi� Woq Pr.m� % �" j�'�� <br />o�ny orni • �{�t?,_L��L�' <br />/ <br />r��an�c Wm�e �ea <br />totniree s <br />Lree �no� fce an�a S <br />a,�a��� o�� � � � r �9 <br />• Centerline of sireet <br />• Indicate North <br />• Show any p�oposed grading r.hanycs <br />• Show measurements <br />Phone <br />PERMIT CONOITIONS <br />1. All cells lor inspec�ion shell be made 24 hrs. in advance - phone 2b9•8850. <br />2. All work shall be pedormeJ in accordance with �his pa�mi� and cwrent Cily ol Eveiett Desi9n and Consirur.tion <br />Standerds end Specilicalions. <br />3. Cell Locatlon Underground Service 48 hrs. belore you dig. TOLI FREE NUMBER 1•800•d24-5555. <br />�l• �,E� ��7r��.Pd �t,� �n1 <br />� <br />L�i <br />App�oved as Conslructed <br />rvr�rlt PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Sireet <br />Everelt. WA 98201 <br />Phona 259�Fi010 <br />�, �� � //-,3 —�� <br />ACKNONL[DGEMEN70F CONDITIONS <br />W <br />� <br />� <br />� <br />0 <br />� <br />� <br />� <br />a <br />7hr undrrs�yne�f ownrU�pphcan� herehy agrees to hold and save ha�m� <br />less Ihe GIy ot Cveietl Irom any and all claims lor tlainn�es, costs <br />I expenses. ui causes ot nction Ihal may arise bec�use ol installilion <br />�� and mainten�nce ol Ihe improvement or o�her righbol-way use hereto <br />Apphed Ier and linther a9rees lo iemove same upon nohre Irom Ihe <br />Date City and to r�pl��ce (fUbl�r, f�roperty domagnd Iheroby <br />Dale <br />fa <br />Siynalure ol ApUhcant — Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTCD WITHIN <br />180 DAYS OF DATF PEFMIT IS ISSUED AND THEREAfTER IS TO <br />B[ OILIGENTLY PURSUE� TO COMPLETION THIS PERMIT MAY �C <br />CnNCELLED �V tHE CITV 11PON ANV STOPPAG[ n� WOFlK ON iHIS <br />PROJCCT OVC17'.10 DAVi DUHAII(1N <br />