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Date � � <br />Applicaliou ror <br />PUBLIC WORKS PEaMIT <br />Print or Type Only <br />� <br />Owner <br />/i'r71 <br />�u�i�c Worke Permu • � � � � _ <br />e�ea oeoi • � -- <br />i'u�IK Worhniea s '�,O (7 Q — <br />Totel Fen <br />Les� AOP� �ea Plid s <br />BAlance Uue s�' U O <br />W 7 E' <br />�i� <br />Fhone <br />CnGUAJr� — - <br />Applicant Meiling Add�ess Cily Zip Phone <br />i <br />Describe P�opooed Work �N=�if�lt� �S :C�//i[ ���.lA'C-7Z= � /('/!/FiU/�� <br />P�olect Address (il known) <br />�,.�.vw�/�- u� �oT %z l�Ckn�i�.r f��r7t � <br />T—� - <br />Attach four (4) coples ol plans for proposed wor �� �rr�w to scnle and note the lollowin{� ns applicable: <br />• Proper!y Llnas • Centedine ol stre�t <br />• Oulline end dimensions al all existing and • Indicale Norih <br />proposed strucWres on the lot • Show any proposed groain9 ..nan{�ee <br />• Exisling and proposed utill�ies • Show measu�emenis <br />P[RMIT CONDITIC�NS <br />1. All cells for inspection shell be made 24 hrs. in advance - phone 259•88� 5. <br />2. All work shell be performod in eccordance wdh ihis permit and current Cily ol Everetl Design and Cor ;�ruclion <br />Stendards nnd Specilice�ions. <br />3. Call Locotion Underground Snrvice 48 �vs. b�iwe you Aig. TOLL FREE NUMBER 1-800•424•5555. <br />� l..�<�_"_ 3 . ` - �"� <br />Approved lo onst tion <br />' Dole <br />. � �� <br />('�IJAi.INS TION ���� <br />Auc�,;e,:d as Gn,,lructed <br />�i�•It PUBLIC WORKS DEPARTMEN7� <br />� 3200 Cedai Streel <br />[veretl, WA 98201 <br />Phone�259�0815 <br />4CKNOWLEDG[tdENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />Thc undersi�meA uwnoqnpplicunt hereby agrees to hold and save herm� <br />less Inn City ol EvereU from any and all cmlms for demeges, cosis, <br />expenses, or causes ol action ihat mey erise because ot inslallation <br />and maintenan;:e ol ihe improvement or other righl�ol�way use hereto <br />applied lor and further aprees to remove semo upon notica Irom ihe <br />Ciry an to repince publlc p�oPerry Aamaged Ihereby. <br />�_ G't� T la �_— -- _ <br />Si alur�� ol � �plic nt Oato <br />OFF AUTHGRIZED BV TFi15 PERMIT NUST HL ��ARfED WITHIN <br />/1�0 DAYS OF DATE PGFMIT IS ISSUED AND THEHEAFTER IS 70 <br />BE DILIG[NTLY PURSUE� TO COMPLETICN. THIS PERMIT MAV Bf <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJCC�� OV[R 90 DAVS UURATIOIJ. <br />