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c/,, /� �'neec Wod�Permn• v✓ _ `�/� <br /> �0t8.�flOL�+�`� PPs��� _ <br /> � • oiaa oeo� • �-�� –�-� <br /> Appllcetlon For <br /> PUBLIC WORKS PERMIT Pum�cWoa��ea — — <br /> �ot�l Fee f <br /> loa�ppl Fee Pud S <br /> P hncn Oue f �O� <br /> Print or Type Only <br /> ��N�;NL.��� �R���' a�ai -IIGr'�.Sf- �F E✓�iptf �,i'z[�k .�z �- �.sx <br /> Owner ailing Address Cily Zip Phone <br /> ` i Meiling Addrnss City Zip Phone <br /> Applicant <br /> I, -- /, Y�—�'I <br /> Daecriba Proposed Work /�'P. � -��w ��7 � `3 � �a— <br /> W <br /> Prole:l Pddrese�il known) 65z 9 '�' CQ.�t/ �'�� � <br /> Aflach 1� 14)eopien ol plane lor proi�oaed work•Draw to scale and note the lollowinp as epplicable: � <br /> � Property Lines • Centerline of straet � <br /> • Oulline and diman6lona of ell existing and • Indicale North <br /> propoaed siructures on Ihe lot • Show eny proposad grading :hanges <br /> � EKIetInB and pro0osed ulitivas • Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> ?ERMIT CONDIT'ONS � <br /> 1.All cells lor Inepec!�un ehel�be mede 24 hrs.in edvence•phone 259•88�0. <br /> 2.All work ehell be pertormed In acco�dence with thia permit and currant City ol Evarell Design and Co�atructlon <br /> Stendarde end Speclflcelions. <br /> 3.Celi Locetlon Underg�uund Service 48 his.belore yau diq TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> i � <br /> � <br /> a <br /> a <br /> , <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> ,.'� The undersignnd owner/appGr.ant hereby egreas lo hold and save herm� <br /> _ lesr. Ihe City nf Eve�etl Irom eny end all cleims lo� damages, costs, <br /> e e��enses, or ceuaes of ection that mny erlsa bec�use ol inslellation <br /> � ,�j- � and maintenance ol the improvement or other ripht�ol�way use here�o <br /> �'-' r 8 epplied lor and lurther eBrees lo �emove same upon notice Irom ihe <br /> ApP�oved lor Con6lru a1e City and to replace public propnrty demeged Ihereby. <br /> / ��-�P /u°%1-�C �.��i_c.�L S -L7- G'd� <br /> FINAL INSPECTION Dete Date <br /> ApprovBd e6 COnetrutled Signetu�e ol Applicent !/ <br /> WORK AUTHORIZED BY THI3 PERMIT MUST AE STARTED WITHIN <br /> p�re�� PUBLICWORNSDEPARTMENT 100 DAVS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> � 3200Cedar9treet BE DIIIGENiLY PURSUED TO COMPI.ETION.THIS PERMI7 MAV BE <br /> Everett,WA 88201 CANCELLED BV THE CITV UPON ANY STUPPAGE OF 1M1ORK ON THIS <br /> Phnne:26B-B810 PROJEGi OVER 90�AYS CURATION. <br />