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-1 <br /> r �- • �L <br /> / � M <br /> r �� (,-( /^/� '� -i 1'ublrc Worte Pe�mill <br /> �8�@�-�" �v e�ae oeoi • _—,�� <br /> Application F� _ _ <br /> P'UBLIC Vl�'ORK PERMIT PuOi�cWor4�fna a <br /> Tal��Poe <br /> .. le0�OPI fee Pe�� S_� <br /> 8 � p p G O f.J �1 Bei�nr,r0ue S � � _ <br /> �fl O O U"� � <br /> Print or Type Only C, y ,o �c o � <br /> M �O � M � � M � ��, <br /> N � N <br /> -� ' �� � - ��(l`��� �����l ���1)_� <br /> � � ,, r ;��- f � �� ' � � '� <br /> � Phone <br /> Meiling A res �` , Y"' � ZiP <br /> Owner � � _ `� � �J � i,,� <br /> Sw � a� `� .i'+ m `��i �.S <br /> Applicant <br /> Meilinq Atld�ess City Zip Phone <br /> C��� iTi�1�'f�T"��'�L�C� <br /> Deacribe Proposed Work <br /> - W <br /> -/ -�----- � <br /> Project Addreae 111 known) �I�,K� Y�- � / � � <br /> � <br /> Altach lour(4)copiea of plena lor Proposed work� Draw to scale end note the lollowing av epplicatle�. � <br /> • Prope��y Lines • Centerhne ol slree� <br /> • Indicate North <br /> • Outline end dimensions ol all e�ishng and � Show any proposed gradmg changes <br /> proposed structures on ihe lot � Show measuremenls M <br /> � E�isling end proposed utililies W <br /> DO NOT WRITE BELOK'TIiIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells for Inspection ahnll be mede 24 hrs.in aAvence•phone 259•8810. <br /> 2.All work ahell be pertormed in eccordence with lhla permit and current City of Everett Design end Constructlon <br /> Standerds end Specilication��. � <br /> 3.Cell Location Underground Service 48 hra.balora you diy.TOLL FREE NUMBER 1•800'424'S555. <br /> � � NE\�/ C/��r�C,� :�..HA�I. iV li"i- C N< k(.•�CH „v�C) �,'�t,a ini O <br /> .- �r a, r� �. � .� c .�.�;J .- li_ 1..�� ��i :.lJL✓�- A C( Y�. <br /> � <br /> � <br /> O <br /> a <br /> IAGKNOWLEDGEMENT OF GONDITIONS <br /> ��i�. The undervgned owner/applican�hereby agrees lo hold and save herm� <br /> less the City ol Everett Irom any and all claims tor dameges. costs. <br /> eKpenses. or causes o� action Iha� may arlse because ol installation <br /> -�� 1�A ( I�� � ��.,. � _ c�/�. and maintenance ol ihe Improvrment or other nghPobway use herelo <br /> 1'�� v epplled lor and further a�rees lo removn same upon notica Irom the <br /> Approved lor Conslruction Date City and to replace pubhr,property damaged thereby. <br /> i) � �� -��(� <br /> Date • 7'G �l��I� ti (l� � <br /> FINAL INSPECTION Date <br /> qpproved as Conslructed <br /> S�gnalu�re ol Ap icant <br /> WORK AUTHORIZED BY 1HIS PERMIT MUSi DE STARTEC WITHI <br /> '� everett PUBLICWORNSDEPARTMENT 1B0 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS 10 <br /> ��I � 3200CedarSlreet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CRV UPON ANV STOPPAGE OF WORK ON TH�S <br /> I Phone�.259�8870 PROJECT OVEF7 BO DAYS DURATION <br /> ��___—____�____ . __. _._ _. . _ . _ _.____ _. __.._ _ __.._______.._—__ .. <br />