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Dete��c ��r,j <br />r � <br />Applicetlon For <br />PUBLIC WORKS PERMIT <br />Print or Tj pe Only <br />y ' / ��,� <br />OWf1Pf <br />_ n � .. <br />� <br />: <br />�^ PnSTING � ' ° 19� � <br />►� <br />P <br />�,��� <br />MAIIITJ Aqd/eS5 GIV <br />Deacribe ProposPd Work ��� <br />Prpject Address UI knownl ��F—._��1 s���_ �vUL/L__ <br />� <br />Zip <br />PubLc WOrM� Pe�m�l � �J�� � � <br />eieo o.o� • <br />v�eiK wen. vea <br />Tal�l F�e � <br />Le�s �OGI iee Pn�J d�/�� <br />B�lence Oue i � //O '= <br />Attach lour 14) coP�ea ol plens lo� :�roposed work � pinv: In .ra1„ .�nn nr,le �hr. lo�lowing as apUlicahie. <br />• Prope!rty LinBS • G!r�nrhnP nl SirpNl <br />� Outline nnd dimensions ol all e�i5ting anA • In��r.alc Nnr�h <br />proposed structures on ihe lol • Fhow any nroposeA 9�admg cpanyrs <br />� E■isUng and proposed utillties • 56nw mrasurernents <br />Phone <br />PERMIT CONDITIONS <br />t. nn cena ror �nepecuon aheu be mede 24 hre. m advence • pnone 259•881 O. <br />2. All work ehall be perlormed in ecco�dance with thla permit end cu�re� �t Clly ol Everetl Design end Constructlon <br />Stendarda end SpaclHcatlona. <br />3. Cell Locetion Underpround Service 48 hrs. belore you dlg. TGLL FREE Ni1MBER 1•800-424•SSSS. <br />� lc�or.t fo .� oor�c �per /�14.,s- a��orovr. � <br />vn � � -9 S. Cc�3.y a/� �.�cc�� <br />qpprovea as consvuctetl <br />�PUBLIC WORNS DEPARTMENT <br />3200 Ceder 8tree� <br />Everett. WA 98201 <br />Phnna:259�8810 <br />ACKNO��'/LEDGCMENT OF CUNDITIONS <br />.s"92 <br />W <br />� <br />� <br />� <br />� <br />� <br />a <br />1 h�� u,�Anrs�qnetl owne� �ay� li i1 he�eby agrees to hold antl save harm� <br />— � INsS Ihp Cdy o� V9rPtVfr pny nnd a�l ciaims lor damages. costs. <br />� r.�irnsrs m uses ��� 1 n Ihat may ensg becxuse of mstallption <br />ianA mainle � e d" n rove �enl org ther ng �� 1•wey use her��n <br />;fpphnd lor an h� � ces lo remove seme u on nolice Irom Ihe <br />i C��!� anA r a iopert Jama ad Ihereb , <br />� D /� <br />S� nat e A t Dele <br />OR A 12EU BY THIS PERMIT MUST BE STAHTCD WITHIN <br />AO AV' DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />ILI TLV PURSUED TO COMPLETION. THIS PERMIT MAV 6E <br />CANCELLED BY THE CI7Y UPON ANV STOPPAGE OF WORK ON THIS <br />PRO.IECT OVEfi 90 DAVS DURAtION <br />