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''-� .l)�.1 — ' `-, i__ <br />T <br />Date�� •� . ,,,,. � ��,���I <br />Application Por <br />��J ��. ::��,J t—. �, <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,� ) �Cc �� <br />Owner � ai��mg <br />qpplicant <br />U09Cri6e Proposrd WOrk <br />ProlectAddrese�ifknownl ,�17 �� ��� '�� 5C <br />City Zip <br />C/� � <br />V�pLc Wer4� Pe�m�� • �v � " / <br />amc oso� • 371� <br />vuoim Worts �ee <br />Tolni �ee a <br />leee�oo�feePuds �J� _ <br />Bebnce Due S .l�4! <br />'�_ <br />Attech four 14) copies of pluns br proposed work � D:aw to sr,ale and note ihe lollowing es apphcable: <br />� Piaparty Lines • Cente�hne ol street <br />• Ou�line end tlimensions ol all exisling and • Indicate Norih <br />proposed structures on Ihe lol • Shew any proposed greding changes <br />• EMlst�ng ano proposed ulilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All celle for inepectlon shall be mede 24 hrs. in advence • phone 259•8870. <br />2. All wuik shell be pedoimed In accordence with this permit and current City of Everetl DesiBn and ConaVuctlon <br />Standerda and Speciflcatlons. <br />3. Call Locetlon Undarground Service 4B hrs. befo�e you �ig. TOLL FREE NUMBEA 1•800•424•5556. <br />q,�°v 1 ��-►r �. v,�de-r d r;"e,,�c'�„�� n� v J�. �-e• ,h c�a I 1ed <br />�. <br />�� � <br />s <br />/ <br />W <br />� <br />� <br />� <br />d� Ci c1 f'C't dt' `;r �' �TG ��; : �� h� A{Y'� G� k�3 J�.�l-.c cu ( v�e-,r'{-1 O <br />1 <br />d•✓� ['�Gl 10GE'-.-1 �' I U'I'� . � <br />.J <br />�����wa,�. n���k �.e, �a�.�,zd� w �-�h ��Ph��l�. �O�n O <br />edey2, �" ��.�-�t � �� ��H t,:�.J�-�. � ���, <br />�^'`�'.`�" �"-�,d� 54�.�•.��d,.�,�tiib+, (��'T���n�;a'�{-ttr ��.�k.c�je a <br />�T�f S Cc�e�., a l �c a cc r�uq -F h7 s lcr� <br />�:e'► ( � �.>�� �79G�i' �o � P�. - �� n 5�C f1�'+i N�c.e��-ir-�e�. . <br />ACKNOWLEDGEMENTOfCOND1Tl NS <br />The undersigned owner/eppllce�l he�eoy hpreea to holtl and snve harm� <br />� lees Ihe CIty of Everatl Irom eny end ell clelme for dameBes, costs, <br />G � I� r� _�^ eKpanses or causas ol ection U�et mey a�iee beCeuee of Installehon <br />Gand maintenance ol Ihe improvament Or othai righDof�wey uee hereto <br />eppl�ad lo� and iwthei agrees to ramove aema upon notice Irom Ihe <br />�uctlon Date Cily and lo repleca Oub6c Fro rty demepetl thereby. <br />s <br />�� %/�� �� <br />%' Dete �.u4'%u- �� �2—%�7 L <br />Approved ea Conelructed ` Signeture af Apphcent Dele <br />�PUBLICWORKSDEPARTMEAT WORK AUTHORi2E0 BV THIS PERMIT MUST 8E STARTED WITHIN <br />3YOOCedvStraet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everelt. WA 98201 BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMII' MAV BE <br />P�ona� 159�BB10 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />� PROJECt OVER 90 DAVS DURATION. <br />