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oe�a��G <br />Appl�catlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />MOINng <br />Malling <br />Ci�y Zip <br />Deecrlbe Proposed Work ��e11A.y � 11Y��lRJL(�ALL��--C-- <br />Prolect Add�eee 111 knownl <br />Pom¢ Wo�Me oerm� •p—/ `� /�� —�—/ /-� • / <br />B�Op Deol I _�y.}�[.f_(�$.r].�_ <br />a�eo� won. r« / <br />tete� ia� { <br />1 eu 11p01 fea P�iE �—�j <br />B�i�nce Uue i `�� <br />Attech lour (4) coolen of plene lor proposed woik - Drnw lo ecale end not�"the lollowing as eppiiceble: <br />• Property Linee • Centerline ol atreal <br />• Outllna and dlmenslons ol all exletlnp end • Indicete Norih <br />proposed etructu�ee on the lol • Show eny propoeed gredinq chenges <br />• Exlsllnp end p�oposaC ulilltlee • Show meeauromenle <br />PERMIT CONDITIONS <br />1. All celle lor Inapection ehall be made 24 hre. In ativence • phona 259•8015. <br />2. All work ehell be peAormed In eccordence with thle permll end current City ol E�e�e�l Deslgn and Conetrucllon <br />Slenderde antl Speciflcetlone. <br />3. Call Locallon Undarpround Service 48 hrs. belore you dip. 70LL FHEE NUMBER 1•800•424•5555. <br />i� A•vy ��ir,.taG a- 7.,�,s Srr� w,tc ,�c'E'quneE <br />CLLI/S/•fUC%O�✓ O/�' Cq7GN d"'DS/A/S TO CNA.VNEL %HE <br />RqiNG1Nl�.� �uw.�Ofi /.t/7b i.,E SiOcr'J'EwF�P, <br />J� <br />(,�,�p.f,t To BE DONE f�� APP.E'adE� SiTE .'�[ �On/ <br />��9r�o f� 7-e6 _ <br />Dete <br />PUBLIC WORKS OEPARTMENT <br />J200 Cedar S�raet <br />Everelt, WA 98201 <br />Phone' 259-BB15 <br />W <br />H <br />� <br />NS <br />The under5lB^ed owner/appllcent hereby aqraea to ho�d and eeva ha�m� <br />leea Iha City ol Eva�ett Irom eny and ell cleimn lo� damegea, costs, <br />B%pB0888, Of C9U6B8 OI SCIi00 �het mey arlee beceuae of Inslelletlon <br />and meinlanence ol Ihe Improvement or other rlghl�ol•way use harelo <br />applletl lor end lurthe� ayrees �o remove aeme upon notica I�om Ihe <br />City end t repleco public property demegad thereby. <br />� <br />Signalura ol Applicant Dete <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE S�ARTED WIiHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Bt DILIOENTLV PURSUED TO COMPLETION. THIS PGRMiT MAY BE <br />CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PPOJECT OVER 90 DAVS DUiiATION. <br />