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Date1��;�'6 B7— .3 <br /> �`uni¢Worwe Per I• <br /> AP,���alion Por [.�ne oeo� . ��/�� <br /> PUBLIC WGRKS PERMIT ������W�,�,��. -- <br /> ,o�.��.s s <br /> Le>��po� Fse F��J s� _ _ <br /> Print or Type Unly 8e1enCeDOe • a0�`` <br /> r �� ,�,r 1=,n�n��aX fP/v,ri5 36i-xnfG, /�Q_ _S �.�_�P�e1� 3.55- 37�3 <br /> Owncr MaihngAtldress City 2'ip Phone <br /> S„� <br /> Applican� Mailing Atldress Cily Lp Phone <br /> n 1 ! / ��_ <br /> DescribeProposatlWorh KPlh,yt�.��� -- �l/�'�j CGc�G/{� __ <br /> .. �r__S"'d� <br /> _ �(-r i <br /> —�._t..� <br /> Prolect Address(il knownl 3��•� ,��/ Jf ' ' � <br /> Altach lour(4)copies ol plans lor proposed work-Orav to scale and note the lollowing as applicabfe: � <br /> • Property Lines • Centedine ol street � <br /> • Oullina and dimensions ol all e.isting end • Indicate North <br /> proposed SlrucWres on�he lo� • Show eny provosed yrading changes <br /> • Existing and p�oposed utililiec • Show mea9urement5 � <br /> DO NOT WRI1E BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls�or inspection shall be made 24 h,. in advance� phone �59•881 5. � <br /> 2. All wo!k s�all be perlmmed m accoidance wilh Ihis permit antl current Gty ol Everett Des�gn and Conslruction <br /> Stantlarde end Specificafions. <br /> 3. Call Locetlon Underground Service 48 hrs. belore you dig. TpLL FNEE NUMBER �•800-4Z4•5555. � <br /> � ��}'/C/9iJ%�c�/J�-=� /�las T fi'E'�,s�/�c /�f��?��j O <br /> i <br /> v�siGn� �ynJ fo.E' No�'%/`�-'E'� cD"'�����,� cv�I�c <br /> �.E'iv.0 � v �c v�'f�'�J cy c r= f/o ��s<_=: �c�fr�c � <br /> /'F'c u��zi,S'ty r'�-�S7�<li' i�-c�. Y/ <br /> / O <br /> u� S/�c ��-'-� �i�'�9//J �-'� <-S'%�.D. �/� Ii <br /> ���\\ ��. ��. <br /> � `, a\` ,.�. <br /> ��{ j (�(�� l�J` ACKNOWLEDGE�4FNT OF CO�DITIONS <br /> _ �'N V,�' (+� �G � The undersiqned owner/apphcant hcreby agrees to hold antl save harn� <br /> ��f� --� less the Ctly ol Everelt Irom any and all claims lor tlamayes costs. <br /> � " � � e�penses, or causes ol aclion Ihat may anse because ol mslallahon <br /> _� , � S- �,� and main�enance ol Ihe improvement or other ngh4ol-way ust� hereW <br /> A r d tor Cons ction aDPGed for and further ag�ees io remova same upen not�r.e Irom the <br /> Dale Gly and •oGlac ublic pro rty damaged Ihereby. <br /> � � �, . i �. -7 �'��___ <br /> '� - ..�i/ !�_ •-L' _/ � / <br /> FIN L NSPECTION ' p��� l - ' � i <br /> �iP Signatur f APP icanf� �— Dah, - <br /> evereu PUBLIC WORKS D[PARiMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> �� 3200 Cedar Street 180 DAYS OF DA1E PERMIT IS ISSUED AND THENEAFTER 'S TG <br /> EvereC.WA 98201 BE DILIGENTLV PURSUED TO COMPLETION THIS P[RMIT MAV dE <br /> Phone 259-BB15 CANCELLED BV THE GITY UPON ANY STOPPAGE OF WORh ON TI1iS <br /> PROJECT O�FR 9U DAY� DUFATION <br />