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� <br /> PuElm Wo�h�Permn• `�_%r� ��,79 <br /> Date�� <br /> Blep DaD�� _� <br /> Applicatlon For <br /> �UBLIC WORKS PERMIT PueTol�ieeFea a <br /> I.au eoni rae�+�n B T�-- <br /> B���nce Due d <br /> d(J�,�. <br /> Print or Type Only <br /> u,�����—,f�2�L''r�S'✓�l�� � S�,o✓nn �1'iP.7.r�,P•_ / 5 �3��/'�S <br /> wner <br /> MeJmg Atldreae Ciry Zip Phone <br /> Sa��� Malling Address Cdy ZIP Phone <br /> Applicent /� 1 <br /> � DeecribaProposedWork � ��Yti� NPar� f//�u/n ' TM �� /� r�'J �-'E� <br /> -- __ - W <br /> Pro�oct Addrese III known) ���4�'—'A SC/S�OF .�i�. _ _�� � <br /> �� <br /> A�.+ch four(4)coples ol plena for proposed work• Draw to acalo and note the lollowing as eppliceble: � <br /> • Property Llnes •Cenle�lina ol street <br /> • Outline and dlmenalona ol ell exislinp end f InOicele IJorth <br /> propoaed atructures on Ihe lot • Show eny propoaed gradinB changes <br /> • ExlatlnB end proposed ulililiee • Show measurerr,ente M <br /> � W <br /> A DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calle lor inapectlon ehall bc mede 2� hrs �n edvance• phona 259•8815. <br /> 2. All work ahall be perlormed In accordence wilh thla permit end cuirent City oi Everett Design ond Conatiuctlon <br /> Slandarde end Specllicetlona � <br /> � 3. Cell locellon Untlerground Service 48 hra.belore You dig.TOLL FREE NUMBER 1•800•424-5855. <br /> O <br /> � <br /> i � <br /> I O <br /> � a <br /> � <br /> � ACKNOWLEDGEMENT OF CQNDITIUNS <br /> �, „1(i The underslgnetl owner/applicanl hereby ep�eee�o hold end sove harm- <br /> V' <br /> lass the Cily of EvereU �rom eny end a" claims tor damages, cos s, <br /> � eapenses, or causes ol ectlon thet may :��Ise becauae of Instellatlon <br /> � / and mainlenance ol Ihe improvement or othei right-of•way use hereto <br /> il��a�� � S/�� ep0lied for and lurther eg•^"a to remove seme upon nolice irom Ihe <br /> Approved 1 r Constructlon ��� D81B City end to�eplece public property demeped thereb�. <br /> FINAL 1 SPECTION , � �/�� Date <br /> AppiovedesConst�ucted Si aWre�o( Applicenl <br /> � WORK AU1110RIZED BY THIS PERMIT MUST BE STARTED WIIMIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cede�Slreet BE DILIGENTLV ?U'iSUED TO COMPLETION.THIS PERMI', MAY BE <br /> Everelt.WA 98201 CANCEllEO f1Y THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259-A815 PROJECT OVEN 90 DAYS DURATION. <br />