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/ <br /> ItB� /� y P�m�c t9m�e F�� <br /> BIJp OePI • � <br /> Applicalion F� � <br /> PUBLIC WORK� PERMIT P���'cWo�hsfea - <br /> Toleliee s <br /> Lfas�OG� feePaiJ S <br /> x � a � 8 � �F, � `�' i0� <br /> Print or Type Only � ea�a��eo�< s <br /> 1''1 � w M ('J C M (��l � <br /> M <br /> �r r�on �f� �z � �x_l�1 ��� y��D�3 �I��n.� <br /> wner Maihng A ros ^�� y� � Lp Phane <br /> `� � � � m �b` � � m `� ts <br /> qpplicant Meiling Atldiess Ciry Zip Phonr, <br /> DeecrlbeP�oposedWark W�/'�T�"`'�C����� — <br /> W <br /> � �Prolect Address Ilf known) � _ <br /> Attach lour(4)copies of plans lo�proposad work• Draw to scale and note the following as applicable�. � <br /> • Proparty Linea � CenterGna ot sireet � <br /> • Outline end dimensions ol ell eMisting ontl � Indicate North <br /> proposed st�uctu�es on ihe lot • Show eny proposed gratling cnanges <br /> • ExisllnB end propnsed utilities • Show measurem:nts � <br /> DO NOT N'RIiE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inepectlon 6hell be made 24 hra.in edvence-phone 259•881 O � <br /> 2.All vo�k shell be peAormed In eccoidance wilh thls permit and current City of Everett Design end Conetructlon <br /> Stendarda end Spacilicatlons. <br /> 3.Cell Locatlon Underground Servir.e 48 i�ra.beloie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 4 . New GzACA6E SI-�RtL N OT �NCQUac.H �ti+-�a OR+4-ir.� O <br /> F'/rzo oF2 Dr�-rti�lr=�c-u.� 2E3p�,t,� .a�rceA. <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> ��w� The undersiqned owner/app6canl hereby agrees to holtl and save harm� <br /> less Ihe Ciry ol Everelt Irom any and all claims lor damages. costs. <br /> r/ e�penses, or causes of nction that may arise beceuse ol ins�altation <br /> �j„ . (1 _�� C.l�f�_ �_ .�j--9� and maintenance of Ihe improvem?nt or rther nghbof�way use hareto <br /> ��4����` applied for and lu�ther agrr.es fo remo�e same upon nctice Irom Ihe <br /> �Approved for Constru tion Date Cdy and to replace pubhc prope�ty damaged Ihereby. <br /> 'C�s ' 1-1�•90 � f,. ( ,/ � �' l ' <br /> FINALINSPECTION Date n���� � �Ll� ��� � G <br /> A�:p�oved as ConstiucteC Signalure ol Ap icant Oate <br /> eve�etl PUBLIC WORnSDEPARTMENT WORK AUTHORI7ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAVS OF UATE PERMIT IS ISSUED AND THEREAFiER IS TO <br /> � 9200CedarSire.t BE DIUGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Evernit WA 98201 CANCELLED �Y 7HE C�TY UPON ANV STOPPAGE OF WOFK ON THIS <br /> Phone.259�8870 I PFiOJECT OV[R 90 DAVS DUFATION <br />