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I i <br /> oeteS��.Fr ,,,��,, wo,,,�.,mp�.-p p�/ — <br /> AppHcatiOn For Biny Deo� • o_9�Z�j..F _— <br /> PUBLIC �iVORKS PERMIT r�1Tnlelen"� :_ --_ <br /> �uu�ooi�e.ve�e S _ <br /> Print orType Only 8.�.�=so�. s _ <br /> S�rVQ l4�✓� '� <br /> Tke goe , �� a soo� G� r�,;��1 E�-p,� ��z -c��— I <br /> O�+�e� Mailing Add•ess Ci1y Tp Phone ' <br /> Applicant Meiling Add�ess (:uy Z�p Phone <br /> Oencribe Prpposed Work O a_Q!U i��n�'1����/I S /V�ii f � i 1 <br /> _ � - -- W <br /> Prolect Addreas lil known) _ __ � <br /> Atlech low(4)copiea ol Olans for proposed work� Draw lo scale and nota Ihe following es applicable � <br /> • Property Llnoa • Centerline ol s�reel � <br /> • Outline and dimenuiona ol ell e�isting and • Indicale North <br /> proposed etructures on�he lol • Show nny proposed grnaing changes <br /> • Eeiatinp end proposed utilitles • Show measurements � I <br /> DO NOT WRITE bELOW THIS LINE � <br /> PERMITCONDITIONS � I <br /> 1.All calls lor Inapectlon shall be made 24 hrs.In edvance-phone 259•887 0. � <br /> 2.All w0�k shell be pedo�med in eccordanca wilh ihis permit and carrent City of Everel�Dnsign and Constiuction <br /> Stende�de end Specllicatlons. <br /> 3.Ce�l Locellon Underground Servica 48 hrs.belore you diy.TOLL FREE NUMBER 1•800•424-5555. � <br /> ����w�����,��. �� � <br /> ��a�' � <br /> O <br /> a <br /> ACKNOWL[DGCMENT OF CUNDIilONS <br /> The undersiyned ownevnpplicnnt hw�eby ayrees to hold und save herm� <br /> �ess ihe Gly of Everett Irom nny and all claims lor dameges, costs. <br /> ekpenses. or causes ol action that may anse because of Installation <br /> and maintenance ol �he improvement or o�her nghPof-way use here�o <br /> Approv8dlorConslruc�iOn Dale A�phcA lo� nnA lur�her a9rees to remove same upon notice from �he <br /> CdY���� to irplaCe P��bLc properly damdg�A Ihnreby <br /> FINAI INSPECTION Date <br /> ApD�oved as Constructed S�9nalure ol Apphc�nt Date <br /> rverett PUBUCWORKSDEPARTMENT WORK AUIHORIZEG BY THIS PERMIT MUST DE STARTED WITHIN <br /> � 3200Cetlar51ree1 100 DAVS OF DATE PERMIT IS ISSUED ANO THEREAF7ER IS TO <br /> Everell,WA 98201 BE DIUGENTLV PURSUED TO CO�dPLETION THIS PERMIT MAV BE <br /> Phoro.259�B810 CANC6LLFD BV THE CITY UPON HNV STOPPAGE OF WORK f1N THIS <br /> PfiOJCCT OV[R 90 DAVS DUF.,TION <br />