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l 6 � <br /> DB�A ' ` � � y/.� , PuClic Wo�Fe Perm�t• � V <br /> AppliCallon Fo/ � p�S TING ��/ � Biey Ueo� • <br /> PUBLIC WORKS PE�MIT P���'<Worw�Fee s _s-z,�— <br /> Totei lee <br /> lefa�Oo� �ee V�iE S-�^ <br /> Bslnnce Dun S�`' � <br /> Print or Type Only ----- <br /> �/qK�y .L Yd/ � /n 8� /b't�/. �I- /l1 u/c./Eco q8'l 7J' 3�s 3-.�o � 3 <br /> pW�e—�� Meiling Address Crty Zip Phone <br /> �� ti �.�/d � L /v83 1�N �t, i.K./�'Co 96']7.f .��5'� •..l0 83 <br /> Applice � Malling Address City Zip Phone <br /> Descrlbe Proposed Work ��-1 k1�'C � � C W C� �� /✓ t� _ <br /> »n� W <br /> Pro�ect Addresa 111 known) ��T � C�f��4 r �J''• � <br /> Adech fow(4)cOpies ol plane lor proposed work- Draw to scxle and note the lollowing es apPliceble: � <br /> • Property Lines � Centerline ol street � <br /> • Outline and dimen6ions of all eristing and • Indicate North <br /> proposed siructu�es c�ihe lot • Show eny proposed grading chenpes <br /> • Exieting end proposed utlliliea • Show meesurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERIAIT CONDITIONS <br /> 1.All celis'or Inspection ehall be mede 24 hra.In advence•phone 259•8810. � <br /> 2.All work ahall be padnrmed in accordence with thla permlt end arrenl City ol Everett Deaipn end Conatructlon <br /> Stenderde end Specificatlone. <br /> 3.Call Locetlon Underpround Service 48 hrs.before you dip.TOLL FREE NUMBER 1•800-424•5555. � <br /> �. S• �cs.�c,,-� � c�� sy~rd _!od�, laoz, �ooy � "�, i� , or`- O <br /> r,rr v�.� ���.cti� - Cn ��,r., �n r�ht-df- uX� <br /> S. LlJ A� �'.P�►'d!r-c- /�.c'� <<� Sf� s v2 A � <br /> / <br /> �o . �rt v1l.�tay�.t.✓ C��� Sf� 3, lo O <br /> / <br /> a <br /> ACKNOWLEDGEI�AENT OF CONDITIVNS <br /> The undersi�neA owneqapplicnnl hereGy agrees to hold end seve harm� <br /> less the C�ty ol Eve�ell irom eny and all cleims lor demagos, costs. <br /> expenses. or ceuses ol aclion iha may erise because OI In6lalletion <br /> � � �' end mnintenance of ih imp e ent i other�ight�obwey uae herelo <br /> applied for end furthe agrees rem ve seme upon notice Irom ihe <br /> qpp e� sVud� •� ��a�e City and to replace ub ic propa da aged thereby. <br /> � � /6 5� <br /> FI AL INSFEC ON ��� �a�e • f0 �, <br /> Approved as Constiuctad Signature oi Applicant ate <br /> � PUBLIC WORKSDEPARTMENT WORK AUTHORI2ED BY Nt�� PERMIT MUST BE STARTLD WITHIN <br /> 3200CedarSireet 180 DAVS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED Tf)COMPLETION.THIS PERMIT MAY BE <br /> Eveiett,WA98201 CANCELLED BV THE C!.TY UFON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�B810 PROJECT OVER 90 JAYS DURATION. <br />