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� � � �-- <br /> �8�e� ' Pu�i�c Wor��Permn• r )�� „j ' <br /> " / elEp Ueo� • � <br /> � Applicetlon For <br /> ` PUBLIC 'VUORKS PERMIT vuoi�cwon�Fee �{�� �' <br /> y Tobl i�e ��--���� . <br /> Len A00�Fea P�iO 6— <br /> 1 � <br /> B��anca Dus s �5��- <br /> Print or Typ9 Only <br /> � <br /> � �r�1c�c�p -�?�E�soc) 3�a4 — �NN���c� �0.�7 `7y.3•-� 5�� '7 <br /> �N,�B1 Meilmg Addiess City Zip Phone <br /> , � —� , i. i . <br /> i � � ` <br /> �� Applicenl Melling Address City Zip Phone <br /> 1 Deecd PropoeadWork �� c- —'���n1 �` <br /> / <br /> . <br /> � W <br /> � Prolect Addreee�il known) � �� � � � ' � <br /> � Attech four(4)coplee ol plane lor proposed work• Drew to ecale end nole Ihe lollowing ae applicable: � <br /> � Properly Linee • Cente�tine of slreet � <br /> • Outline end dfinensione ol ell exislinp and • Indicate North • <br /> propoeed etructuree on Ihe lot • Show eny proposeG BradinB chenges <br /> � • ExlstlnB end propoeed utllillee • Show meaeurumente M <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All celle lor inspecllon 3hell bA rnade 24 �ra in edvence•phone 2Fi9•8815. � <br /> 2. All werk ehall be peAormed In eccordence with Ihls permll and current City ol Everett Desipn end Coneliucllon <br /> Standarde and SDecllicetlona <br /> � 3. Cell Locetlon Underpround Servlce 4B hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5585: � <br /> � <br /> � �! �-�,- �/'�"��/�/s ����� 8�s- ��1 , 0 <br /> ' � � <br /> � N <br /> � . � <br /> � a <br /> � <br /> s <br /> � . <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> 3 <br /> � ' The undersigned ownar/applicant hereby epreea lo hold end eave harm- :.�� <br /> less the Gty ol Everett Irom eny and all clalms lor dameges, coete, �,�, <br /> � expenaes, or causea ol ection that mey erlae becausa ol inalellallon ^_� <br /> --� �� ��._�� end meintenence ol ihe improvement or othe� righbo4wey uae hereto r <br /> I( epplied lor end lu�ther egrees to remove same upon notice Irom the <br /> j Ap ed lor op8 ru n / Dele Clly end o replece public property demaped ihereby. `r;i <br /> //'�� y <br /> � � 1 / � ��i�d�/ � � �•���r ' <br /> Q�// <br /> �� FINAL INSPECTION ` Dele <br /> 1 Approved ae Conntructed SlBneture AppNcent Dete <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MU51 BE STARTED WITHIN <br /> i everett 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTEA IS TO <br /> � 3200 Ceder Street BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259•BB7 5 PROJEGT OVER 90 DAYS DURATION. <br />