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�� ��y�` / <br /> Da!e1L—_ / � v„m��wo,xsv.�mn/.� pn-y9j <br /> App6ca�ion For ema oec� • `7�—+Z-�� <br /> PUBLIC WORKS PERMIT °°°°<W°,�•F°° - - <br /> Tal�lfee s <br /> leaf�DCI fen Pa� S <br /> PfIM Of Typ@ Oflly , e�ie��so�s S�� <br /> /1/e.�,l lt> • L'tzun.� �i9 �� C�vY Ev 9�av� �9-7"�osj <br /> Owner ading Add�ess Cny Lp Phone <br /> Ou��.e c� <br /> Applicant Maihng Atldress Cdy Zip Phone <br /> Describe Proposed Wmk v � � — — <br /> Prolect Address(il known) _ �S7 �� , � `�'"�-�^ —�-� � '�, <br /> � ' <br /> Atlach four(4) copies ol plars lor proposed work� Oraw to scale and note Ihe tollowing as applicable: � ! <br /> • Property Lines • Centerline of stree� � <br /> • Outhne and dimensions ol all e�isting and • Indicale Norih <br /> proposed structures on Ihe lot • Show eny propos tl greding chan9es <br /> • Existmg and proposed utililles • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS M�025968 <br /> 1.All calis lor Inapeclion ehall be made 24 hra.In advance-phone 259•881 O. �-� f102.15 <br /> 2.All work ahell be pedormed in acwrdance wilh this pe�mit and current City of E+erett Desi��onstru� � ��� <br /> StandardsandSpecifications. URVWV 520.00 i <br /> 3.Ca�l Locatlon Underg�ound Service 48 h�s.before you dig.TOLL FREE NViNBER 1�800•��555�126.65 � <br /> . O�j�. /�e%fD✓L Qn�✓ /^G��laGe Sid'l✓a.L,f' ��� lcr�u. G� <br /> N <br /> fhc r��•�� c�ri✓rc�n�/. � �+/„c.E) H <br /> . <br /> � <br /> O <br /> a <br /> ��, q� ACKNOWLEDGEMENT OF CONDITIONS � <br /> ���, <br /> V The underslgned owner/appl�canl he�eby agrees lo hold cnd save harm- <br /> less Ihe Clly ol Everel� Irom any and all claims for damages, cos�s. <br /> // / ezpenses, oi causes of action Ihal may arise because of installation <br /> ����� // � n and main�enance o� the improvement or other nghDof�way use herelo <br /> app6ed for and lurther agrees to remove same upon notice from Ihc <br /> Approved lor Constru � Dale �;ity and l0 replaCe public property dama�etl thereby. <br /> � �� � �/ ` "� ` <br /> FINAL INSPECTION Dale �1 `' u � � )•�' i 1 � i i U <br /> Approved as Cons�ructetl Sipnalure ol ApPlicant Date <br /> WORK AUTHUFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUBLIC WORKS DEPARTMENi 180 UAVS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 3200CederStreat BE OILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY 0E I <br /> Everell,WA 90201 CANCELLEU BV THE CI fV UPON ANY STOPPAGE OF WORY ON THIS <br /> Phona:259-8810 PROJECT OVER 90 DAYS DURA710N. <br /> � <br /> I <br />