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oate� ( L 6_j7� <br /> �•„�,��. wo,,,�r„�„. y� <br /> AppLCalion For Biap Oeo� • �_ C-- _ <br /> P:lSLIC W�ORKS PERMIT �--- - - <br /> Puolr[Wmp Fne <br /> To��l Fee S�_ <br /> ��+��no� fee Vna S� <br /> Prin! or Type Only ee„��a o�s s��� <br /> /� , , <br /> i <br /> �.�i c � �.�-�+^ �c'r...,��c� �-� -30/–��fAP' W. C✓E E77' �J ' J i�.� <br /> Mai6ng Address Ctly Lp Phone <br /> _�--4—{y�.f��' <br /> Applicanl Mailing Atldress City Zip Phonc <br /> Describe Proposed Work ��'� <br /> Project ACdrese(il known) ��=�T 3�f/2 _ ,BE�L ST � <br /> Attach lour(4)r,opias ol plens br proposed work� Draw fo scale and nole ihe iollowing as appficahle: <br /> • Property Lines � <br /> • Cnnte�lin;ol stier.t � <br /> • Outline end dimansions o�all enstmg and • Indicato North <br /> p�opoeed st�uclures on the lot • Show�.ty proposed grnJing Changes <br /> • Existinp and prnposed utdihes • Show measuremenls <br /> DO NOT WRIiE BELOW THIS LINE � <br /> PERMIT CONDI710NS O <br /> t. All calls lor inspectlon shall be made 24 hrs. in advance- phone 2S9•8$�5. <br /> 2. All work shall be pertormetl in accordence wlih this permll and current Gity ol Everelt Design antl Conslruction ' <br /> Stantlar�s and Specilications. <br /> 3 Call Location Underground Sernice 48 hrs. before you dig.TOLL FREE NUMBER 1•$00•424•5555. � <br /> ,/ � <br /> 7'• .�'Fir�ov� E.risri,vCs Cu/��/ lralTF� fi3c�o SivEu/Ha,� O <br /> PE.(' SECT�n�J .�3, 7 C� T.rr' tLB.c il tcloet vE'S.G.J <br /> � C�O.dST.PGC.Tionl �};?.✓!a!t�'�,pS . �cSEF h'niJC//E'p> A.c./O � <br /> IO.Si�I� l�,G/b'EleJfJf/ /�.f S7JS»�f/�F7�P/J )0'JO7 � <br /> a� �Eira�E �P,ao .e'c-'�19�E' �isr.v� c�.eo.rF.✓ � O <br /> S/OF<J�PC.0 /'�`< Tji� j����yC;L !"JOl'f,f• f.t/S�Z C'T�QS <br /> r.J.ST-PUCTip/�.CS, � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> --- __ ___ ih;�undcrsyned oNne�/appllcant hereby agrees lo holA and save harm� <br /> — less !he Gty ol Eveiett Irom any end all claims lor damages. cosls. <br /> / � expenses, or causes o� achon Ihat mny ense becx se o� inslallahon <br /> ' /�-j�j-�� � � g antl mainlenance ol the improvement or olher righl�obway use hereto <br /> � '✓ /Jy c <br /> Appioved for Cnnstructi i pa spP�ied lor and luriher agrees lo remove seme upon no6ce from Ihe <br /> T City and to replace pubhc property damagad ihereby. <br /> �— / � / � <br /> , ��� ,, l�, -f l � �� -��� <br /> FINAL ION Date / !�L' / L �/�' //--��` <br /> Approvetl as Conslructed i9nature o p�nt �--„ �� / � <br /> Oate <br /> evrrett PU9LIC WOFKS DEPARTMENT WOAK AUTHnRIZED BV THIS PERMIT MUST BE STARTED WIIHIN <br /> � 3200 Cedar Sireet 180 DAVS OF DATE PERMI7 IS ISSUED AND iNEFEAFTER IS TO <br /> Everett WA 98201 BE DILIGENTLV PURSUED TO COh1PLETION TNIS PERM111i MAV BE <br /> Phonr 259�8815 CANCELLED BV THE CITV UPON ANV STOPPAGE pF WORK ON THIS <br /> PRUJ[CT OVER 90 �AYS DURATION <br />