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DetB � �///�{ Pum¢woa�Permn• <br /> —�'!"� �� 58 F3 <br /> ama oso�.•� <br /> Appllcatlon Far <br /> PUBLIC WORKS PERMIT °°°To,':°ieeFea � <br /> Leu�oo��Fae Pud � <br /> Bai�nceDue f <br /> Print or Type Only <br /> /���j�_�i, e r,��i t� l 3/3 ��tl�L� �.Y��A� �'1d�3 .�97 57v��._ _ <br /> Owne� Meiling Addresa City Zip Phona � <br /> .r <br /> �fMtn �/� IG��I ,.renlmlll� /r�,�U �0 7`��-�J`,.tJ r' <br /> Applicant Mall n A dreas Clly Zip Phone <br /> r. .. <br /> —1 �1 <br /> �' �u � '�" a 4� � ►� -i <br /> Describe Propoaed Work �. �m <br /> 0 <br /> — c c,� <br /> m 75 <br /> W �� <br /> � I � m � <br /> Project Addreae(il known) �-7J-3 � Q = <br /> Attech four(4)coplee of plena lor proposed work• Draw to acale end note the lollowing as eppllcablP: � <br /> • P�operty Linea • Canterlino ol atreel � _ <br /> • Outline end dlmenelone ol ell ezlatlnp and • Indicete North � �N <br /> propoaed atructurea on the lot • Show eny D�oposad greding chengae � <br /> • Exlating end proposed ulllitiea • Show mean��rementa M �j A <br /> w -�1� <br /> DO NOl WRITE BELOW THIS LINE �� m� <br /> PERMIT CONDITIONS N <br /> 1. All celle for Inapection ehell be made 24 hrs. In edvanca- phune ZS9•88�S. �� �N <br /> 2. All work ahell be perlormed In eccorder.�e with thia pannit and current City of Eve�ett Design iend Conetructlon 3 H <br /> � Stenderde end Specllications <br /> 3. Cell Locetlon Underground Servlce 4B hrs.belora you dIB.TOLI FREE NUMBER 1•800•424•5555. � �m <br /> . � <br /> Os <br /> �O �U�S'�ic L�.>G;c�.�s s�,t�riiT ,f'Ef�ai�-'E� _ <br /> � � <br /> � <br /> ��'„" ✓ /-7 1�6 � � <br /> � <br /> 0 <br /> � � <br /> � <br /> m <br /> a <br /> ACKNOWLEDGEMENT OF CONDIiiONS <br /> The undor9iBned ownor/applicant haieby eg�ees lo hold end eeve harm� <br /> less the City ol Evrrelt Irom eny antl ell claime lor damage& coat& <br /> expenses, or Causes of ection that may arlse beceuse of instellellon <br /> and malntenence ol ihe Imp�ovement or other right-ol�wey uae hereto <br /> epplied for and luriher egrees to remova seme upon nolice irom ihe <br /> Approved lor Conalruction Dete Clly end to ieplece public proparty demaged�hereby. <br /> FINAI_ INSPECTION Dete Dele <br /> Approved es Constructed Signelure ol Applicent <br /> — WORK AUTHOFIYED BV THIS P[RMIT MUST BE STARTED WITHIN <br /> everet[ PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br /> � 3200 Cedar Streot BE DILIGENTLY f URSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everelt,WA 98201 CANCELLED BV THE CITV UPON ANY STOPPAIiE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAVS DURATION. <br />