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� <br /> �6t@�� 1 Pum¢wo�k�Pm �� <br /> Appllcatlon For eiao oeo�.•� <br /> PUBLIC WORKS PERMIT PuE1�cWorM�Fea <br /> ToblFee s_. <br /> Leu�00�Fee PaiC � <br /> Print or Type Only Bniance0ua S ��� <br /> �J/-V I�-J Il .�L`��'-" ' �•=' 4 N -1 �l lCI Y.UI ���,�) � � ��� <br /> Owner Meiling Addrese � City Zip Phone <br /> � Ap�� MellingAddress City Zip Phone <br /> Deec. ribe Propo ed Work `,�� - <br /> �� c.�r� �1 �''�,� � ,�c� � <br /> 1 ll C <br /> 1 <br /> W; <br /> �, Pro�ect Addreee(II known) ' E CAS/N� � � <br /> Attach four(4�coplee of plenn lo�proposed work• Drew to scele end note tha following as app�icable: � <br /> • PropeAy Llnae • Ce�terlina ol atreel � <br /> • Outllne end dlmenaione o�ell exieling end • Indicele North <br /> p�opoaed etructures on Ihe lot • Show eny proposed g�eding chengea <br /> • Exletlnp nnd pro0ased ulilitlea • Show me��aurements <br /> � <br /> DO NOT Yn71TE BEIOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All celln lor Inepectlon shatl be meda 24 hra. In edvance- phone 259•8815. <br /> 2. All worn ehall be perlormecf In accordance with this permil end current City of Everell Geelpn end Conatructlon �, <br /> Standarde and Specificatlons. <br /> 3. Cell Locatlon Underpround Service 48 hrs.beloie you dig.TOLL FHEE NUMBER 1•800�424•5555. � �� <br /> ',r Dp NUT G.PAO.f �or To Aov.�.e.r� � E«Ec r O <br /> AD.Toi^��/�'✓U A.�oPE�•fS Idi/.�✓ .P9iN [.�G��4 .ft'.�/�/C� <br /> 1 �'� ,tNSiqLC SiG�i.ipC.� �GON� F,Fp�/Ti96� fE"2 � <br /> Ci!'�/ cfr.�+vo.9.ed +� 304� �•�n•�c.✓En) N <br /> �. ?nlSrycG �`W D,�'�vE�q� f�lP �'iT� .Ss9�✓!J�',� '�307 O <br /> y.�A SEcr.nnJ 3 3,7 ��'n.o�,s-.r-n) � <br /> ', / � ACKNOWLEDGEMENT OF CONDITIONS <br /> �f�i � �/� Theundersignedownei/applicanlherebyagreestoholdendsav�haim- <br /> leas the City ol Everelt irom any end e�l clalma for damaQe4 coat0. <br /> eapenaea, or cauaes ol actlon that mey erise becauee ol Inllallatlon <br /> — end malntenam;e ol Ihe i�nprovemenl or nther rlpht-ol�wey ufe hereto <br /> ADP� �ed I onet uctioi r Dete applle.i lor and lurther agreea to remove aeme upon noticllrom IM <br /> Clly end to replece public property demeged Ihereby. <br /> FINAL INSPECTION Date � L'�� <br /> Approved se Conslructed S Bn re o Applicent ' Date� <br /> everett PUBLIC WORKS DEPARTMENT RK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITNIN <br /> � 3200CedarSireet 1B(1 DAVS OF DATE PERMIT IS ISSUED AND TIiEREAFiER 13 TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PEHMIT MAV BE <br /> Pl�one: 258-8815 CANCELLED BY THE CITY UPON ANY STOPPAOE OF WORK ON THIS <br /> FROJECT OVER 90 DAVR DURATiON. �� . <br />