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.$a.,.�'�Uu.G:.� /a-'�-8e <br /> DBtB__ ,��eim�vo�xa ve�mn• �g �� <br /> Applicallon For � eiac 000� • _ <br /> PUBLIC WdRKS PERMIT L Puhli[WorFfFN , �=-- <br /> F�� � Tot�l Fee S 7� <br /> �2 leaa�ool Fee Pua S_�_ <br /> Print or Type Only <br /> /D ✓ BelanceDue � �� <br /> 1 �va ly � . � i�l��.i�SS�h) ���h�l �-.�Si I`(� A7 � j�Qy$v�i�l _ rt'�i'2`f0 <br /> Ownar Meiling Atltlress Gry Zip Phone <br /> sc�.,.;� <br /> h'�5 •��� 3 <br /> Applicent�— MailinpAddress Cd <br /> Y ZiP Phone <br /> DeecribeProposedWo�k {►1,1/tll.��tJ �R �� 1 �i �' SFi.���t �,�N—t _3� 1 4 <br /> -����— �—=�"T�� �� +7i—�1�l�Th 1 L �^9 Fv i? 1 r-M i w.!'n.�� �'A(� <br /> Pt� c� �. �; t A ��-_m��a PT4.� � cP�• <br /> �. P ��,�Z =�- �7 W <br /> � ProlectAdtlresaplknown) �+��'� CRhy �R� � <br /> t Attach low(4)coplea ol plann lur proposed work•Draw lo scale and nole the following as upplicable�. � <br /> j • Property Linea • Centerl�ne oi street � <br /> • Oulline and dimenaions ol ell ezisting anA • Intlicale North <br /> proposed siructurea on ihe lot • Sho�.v eny proposed gretling changes <br /> � Exletinp and pioposed ulilities • Show measuremenla � <br /> DO NOT WRITE BELOW THIS LINF <br /> PERMIT CONDITIONS O <br /> 7.AI!calle lor Inspecllon ehell ba mede 24 hre.In advence•Fhorie 259•8810. � <br /> 2.All work ehall be peNormed in accordance wilh thie permit end a�rrent City ol Everett Daelgn and Consiructlon <br /> Sfendarde and 3pecilicetiona. <br /> 3.Cell Locatlon Underpround Service 48 hre.belore you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> � �.w C� SFrt' '� G d l� !�a L� � o.� �, 0 4 Z <br /> ,S^ �Qc�nn�P� /I.�to� �e�-� O <br /> G , Drr ����^ C,� S �J � 303 N <br /> � <br /> a <br /> ACHNOWLEDGEMENT OF GONDII IONS <br /> The undersigneA owne�/applicant hereby egrees to ho10 nnd seve ha:m� <br /> � less Ihe Ctly ol Everetl Irom pny and all claims lor demeges, coata, <br /> � eMpenses, or causes ol ection �hat mey a�ise because ol Inslallatlon <br /> ��� � �S_- G .�L end mainlenance ol the improveman� or other �ighbo4wey uee harolo <br /> —�� epplied lor end Iwlher agrees to remove same upon notice Irom the <br /> ADO vetl or Con lion Oale C� r�lo replete pubhc proparty dameged ihereby. <br /> �� /��7'�j \ <br /> FINAI IMSPECTION Dele � -14 •�Q <br /> App�oved ee Cunatruttetl Signatu J p iceM pnte <br /> eve�ett PUBLICWORKSOF.PARTMENT WORK AUTHOR17E0 BY THIS PERMIT MUST BE STARTED WITI11fl <br /> � 3200CedarStroel 1B0 DAVS OF DATF PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> Evaret4 WA9B201 BE DILICENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-8810 CANCELLED BV 1HE GTV UPON ANV STOPPAGE OF WORK ON THIS <br />, PFOJECT OVER 90 DAYS DURATION. <br />