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Date P�nim Wone Perm�i� ��—/��— <br /> B�ny Oeo� • -- <br /> ApP��cntion Fur <br /> PUBLIC WORKS PERMIT °°°:a.°^;°„ � — <br /> Lnw�o�� �ee Vud 5—__ <br /> e:.��e o�� <br /> • ap—o° <br /> Print or Type Only <br /> �A�� �U��L'�'c. <br /> � <br /> ��c�l.! �sT � �.JC 17��� t�11� d'7,r,C-F ��i Z �►�aJD..,+� �F,� Z <br /> pW�e� MailingAddress Ctly Zip ' Phone <br /> —��!`�'L� � E�'�—���0 D <br /> Applicenl Me�ling Atldrr.ss City Zip Phone <br /> Deacribe Proposed Work � M�'aT�l_ �� �-'L M�'�S- �1/aL- ( /a1�j-���• Ld� C�� <br /> AN o Con�s;�e uc r 5,�, �e. <br /> - W <br /> P�olect Address(il known) � aT �{. (�,p,Sll.l O j.'�+AD ^ 1 � O�i �45r CiISiAI n QoAf� � <br /> Attech lour(A)coples of plens lor p�oposed work- Draw to 6cale end nota the following xs applicoble-. � <br /> • Proper�y Linea • Cente�line ol slreet � <br /> • Outline and dimansiona ol ell existing end • Indicate Norih <br /> proponed atruclurea on Iha lot • Show any p�opused grading cnanges <br /> � E�IstInO and p�oposed ulilitiee • Show ineasurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inepecllon ehell be mede 24 hra.In edvence-phone 259•88�0. � <br /> 2.All work ehell be perlormed In eccordance wlih ihls permit end current City ol Evxrett Dasign end Consiruction <br /> Standerde end Specllicallone. <br /> 3.Call Locetion Underpround Service 48 hre.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � 1 .!t/87�-.� �r.o �ii O�Ori.L �-�a Q�yoZ�e� �Q(�a..t� O <br /> .�o:, dna.,n�� ,S�o.T�.�.� o%fe.� S- 6 - 8B . <br /> .�.- rl..at.P� Q S �ut�v .G�o�wP� -Bcil.:.�V �t.��.�� ,c«6 � <br /> r.�no.l''a.lf o�'u:.�i� ��, ,c��'r� �.ul�� �✓.�'07 a�.o��a46 ��> <br /> �ov2 ,o�-.:,,.�,/� ��r,���c 0 <br /> a <br /> ACKNOWLEDGf.MEN1 OF CONDITIONS <br /> The unAersigned ownevapplicant hereby agrees�o hold.�nd save ha�m� <br /> -- --- Irss Ihe Gty o� Everelt Irom any and nll cleims lor damnges, cosls, <br /> / e.penses. or causes ol actlon Ihat may arise because of instellnlion <br /> ��/"'-"' �6b13- .s//'cQ ond mainlenance ol ihe imprnvemen� or o�her righ4of�weY u5e here�o <br /> apphed br nnA lurther agrees to remove seme upon nohte trom ihe <br /> Approved onstruc�ion Dnte Clty a d to replace pub�i operty dameged Ihereby <br /> � �� / <br /> G' .1/�';z,���a��� //�7/.$'> s . �g• 88 <br /> � <br /> NAI�t�V^�'�ETa— � a�e <br /> Appiovatl as Consiruc:ted igna ure ol p Detc <br /> everett PUBLIC WURKS DEPARTMEN? WORK A RIZED BV THI �MIT MUST BE 5?ARTEp WITHIN <br /> � 180 DA F DAiF PERM17 IS ISSUED ANO THEREAFTER IS TO <br /> 3200 Cedar 9�reAt BE DILI TLV PUHSUFD TO COMPLETION THIS PERMIT MAV BE <br /> Everell.WA!38701 GANC[LLEO BV THF GITV UPON ANV STOPPAGE OF WORH ON THIS <br /> Phonc.259�0810 pROJ[CT OVER 9U D�VS DURATION <br />