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°e,e�'�"�� TO POSTING_ <br />' Appllcetion For <br />PUBLIC WURKy PERMIT <br />Prfnt or Type Only <br />Vuphc WOM1� Per / D �/0� <br />BIEp DeO� • <br />Punbc worb fas <br />iolelfee i <br />Le�e �ooi Fee Pud i_ <br />B�I�nceDue i �7� <br />Applicent <br />rNamnp <br />Deecribe Proposad Work ���1��� <br />Pro�ect Addresa (11 known) <br />aiy <br />Altech lour (4) cop'�e6 0l plen6 for proposed work • Draw to acele entl note the Iollowing es appliceble: <br />• Property Llnee • Cente�line ol streal <br />� Outllne end dimenelona of ell exisling end • Indicate No�th <br />proposed elructurea on the lot • Show any proposed grading chenges <br />� Exletinp end propoeed utilllles • Show meeauremenle <br />PEFMIT CONDITIONS <br />1. All calls lor Inepectlon ehall be mede 2a hra. In edvance - phone 259-8810. <br />2. All work ehell be parlormed In acco�dence wlth ihla permit end current Clly of Everett Dealgn end Conatructlon <br />Sfendarde end Speclllcatlone. <br />3. Call Lxetlon Underprountl Servlce 4B hro. before you dip. TOLL FREE NUMBEH 1•800-424•5555. <br />�, .itfa� G�/oi.� -�a �e do�,.ei ��- l¢Pa�.� 4�1`.`0""' <br />On. a• is 90 . ( Co�y ��ki,e %%� <br />everett PUBLIC WORHS DEPARTMENT <br />� 3200 Codar Slreet <br />EvaretG WA 88201 <br />Phone:259•8810 <br />�� ,� :� s.i. � i �;T'ri ��YJ <br />/ <br />1100033141 <br />OP?.20 t17.50 <br />� � �.� <br />�� ��.� <br />� �.� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/epplicant here6y egrnes to hold end eave herm� <br />lees the City ol Everelt Irom eny end all clalms lo� tlemaBes. coets, <br />erpenses, or ceuses ol ection thet mny orise beceuse ol Inatalletlon <br />antl r�ainlenance ol Ihe improvemenl or olher righ�•of�way use hereto <br />epp� ed lor and lurthnr agrees to remove sema upon notice Irom the <br />CIP � and Ip r�nce public pLoperty dampyed thare6y. <br />m <br />� ���' <br />� �: : <br />WORK AUiN IZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS O DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON T"'� <br />PROJECT OVER 90 DAVS DURATION. <br />