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� �1/ ��, _ yy3 <br /> �8te � ••7 p fji _ Pueirc wor�e Fermn• <br /> Blnd Dep1 • <br /> Application For <br /> PUBLIC WORKS PERMIT Pueiol�F�c`ee a — <br /> Leea�DOL fee Psid S <br /> Bel�nce Due S ���'��' <br /> Print or Type Only t? I���,J j �js�� <br /> s�ND RI�. ��° �EJ <br /> ro 3n E, �A ; 5'S-s'3�:--� <br /> GASG.q17� GHURGI-� 130X�9��� � , 98 �3 <br /> Ownar Meiling Address City Zip Phone <br /> T11���I��g►�� �D� 92�1t� sW M L.,T 98G�3 77��3s <br /> Applicent Meding Address City � 2IP Phone <br /> Deacrihe Propoaed Work (���`/ �,• � ��� � ! � ��`� .�--1 ' •� <br /> �Al�� 1 � ��-r _ <br /> S/TE. L'l�G�7�E S i9�r/O �4�UTl�c F S/OFc��f�C.�f� . <br /> /' ,[�� W <br /> Pro�ect Addresa�II koown) �D �� �s--�J-..t � <br /> Atlech lour(4)coples of plena lor proposetl wmk- Draw to scale end note the lollowing as appliceb�e: � <br /> • Property Linea • f.enta�lina oi sireet � <br /> •Outline end dlmenaions ol ell existing entl • Intlicate North <br /> propoaed structures on the lot • Show nny proposed grading chenges <br /> • Existing end propoaed ulilitiee • Show meas�rements � <br /> DO NOT WRITE BELOW THIS LINE O . <br /> PERMIT CONDITIO4S <br /> 1. All cells lor Inspection shall be made 24 h�s. in advence-phone 2b8•88�5. � <br /> 2. All work ehell be performed in eccoidance with ihis permil end current City ol Everofl Design end Consin�ctlon <br /> �tantlerds and Specllice�ione. <br /> 3. Celt Locetian Underground Service 48 hra. belo�e you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> f� �'ii�- Lc1O�f;f TU 6'E ,t�c��f f�e:� /�s'i-?cn��c��0/86 12:07PM OOOAHa^65 �t <br /> G�/.',,�./..✓CS /�la�EL� /O�77 -6'� / <br /> ��9-., .q.�,v c'-, � a000iro� � <br /> ELDG f1619.50 � <br /> E SRCH s].50 <br /> DFT.20 E35.38 O <br /> PW FC 5�6.19 <br /> FWIN&F 1163.70 � <br /> DF�T.20 l3503.50 <br /> CHECf; l5349.77 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undr.rsigned owner/Bpplicent he�eby agrees to hold BnA seve ha�m� <br /> — less �he Ciry of Everell irom any and all claims lor demepes, c�.ists. <br /> expenses, or causes ol action Ihet may erise beceuse of installerion <br /> �C,// / /s-�, `' and maintenance of the improvement m other right•oFway use hemto <br /> '%1L �.f�� (""L'�s� ���� S7��C+ npplied for d urlher e r o remove sam� upon natica Irom U�e <br /> Approved lor Co stry@tion _ � / Dete City end re ro u P�op y d eged thxreby. <br /> /1 1 ' �IgJ <br /> i�i�°� � b? . - /a- .� <br /> FINAL INSPECTION �A�e � <br /> ApproveA es Construclad S natwe of Applicant �e <br /> everett PUBLIC WORKS DEPARTMEN7 ORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTEH IS TO <br /> � 3200 Ceder Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett.WA 90201 CANCELLED BV THE CITV UPON ANY S10PPAGF OF WORK ON TNIS <br /> P6one: 259�BB15 PROJECT OVER 90 DAVS DURATION. <br />