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�e�@�� . PuMlcWork�Permll• � <br /> APPlltetlon For nieo.onm...8�• s� �� <br /> �' PUBLIC WORKS PERMIT �` rue�����Fn ' s <br /> 1 <br /> vLq��ppl Frs P�IE � <br /> PrintorTypeOnly Y�v� e.�.��ao�._ �.3Z.S�3� _ <br /> ?14- �`18 <br /> ��,�vYlol2� )NG. �211 2a�� sr' scv_ surte 202. (..�NNkX�D WA .9B0 <br /> Owne� MellingAddrees cuY zip Pho„�3 77/ z3� <br /> �'�►v� �► - D�s��J h���--r�c 4230 lq8�r� s� sw, �rNn,wa� �'8a,311 <br /> Applicant Mniling Atldresa City Zip Phone <br /> DeacrlM Proposed Work _�1�7 CCI��� <br /> Projeel Adarxen(if known) Z� l�✓0 � �'w�'l°�11�� — � <br /> At18Ch lour(•1)c.oplea ol plenc lo�p�oposed work- Draw to ecalA end note tha following as epplicable: � <br /> • Pioperty Llnea • Centerline ol street � <br /> • p�tline end dimenalone cl ell eMisling end � litdice�3 Norih <br /> piopoeed structuree on the lot • Show any propused gradlnp chenpee <br /> • E.Isting end proposed utllitiea • Show meesurementa � <br /> DO NOT WPITE BELOW THIS LINE O <br /> PERA7IT CONDITIONS <br /> 1. All ealls lor InspeCtion ehell be made 24 hre.in edvance-phone 259•B8�S. � <br /> 2. All v�ork ehall be peAormed In accordance wlfh this permil and currenl City ol Everett Design entl Constiuction <br /> Stenderde end Specillcatlons <br /> 3. Cell I.ocation Underground Sarvlce 48 hrs.bafore you dig.TOLL FHEE NUMBER 1•800•424•b555. � <br /> �Cj. `./Q� �/���'y�_Q.�(�'(�� <br /> I / O <br /> � <br /> � <br /> O <br /> a <br /> AG�.NOWLEDG[MFN?OF CONDITIONS <br /> The undersi4ned owner/applicarl nereby egiees ta hold and save herm- <br /> less the C�ty ol Everett Irom eny end all clelms lor damagas, costs, <br /> ezpenses, or causes ol ecti�n Ihet mny erise beceuse ol Ins�altation <br /> � end maininnance ol the impwvemant or other righ4of-wey use hereto <br /> epplied for and lurther egrees to remove same upon �otice from the <br /> Appr ed I o r ion Dete Cily an to replace public propc�ty Jameged Ihe�eby. <br /> _ � � <br /> � <br /> FINAL INSPECTION Date � ��--7 'c:� <br /> Approved es Consiruc�ed S nature of Applicent Dete <br /> everetl PUBLIC WORKS DEPARTMENT ORK AUTHORIZED B THIS PERMIT MUSi BE S7ARTED WITHIN <br /> � 3200 Cedar Slreet 180 DAVS OF DATE PERMIT IS ISSUEO ANO 7HEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TH:S PERMIT MAV BE <br /> Phone: 259�8B15 CANCELLED BY TkiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />