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Dete�(t� 1 r•� . <br /> 1'ubhc Worhe Perma• <br /> Applicetlon For Biay ovoi.• �� �� <br /> PUBLIC WORKS PERMIT Poolm'Vorw�Fa� <br /> Tot�IFee s_ <br /> Leu�Oo�fee Peuf s <br /> Print or Type Only e.�.�«o�� s__ <br /> �ixaiur T2r- �'rJ. �l� ,4i,�v ��r �' �✓,U,t�,�r�,r /I T <br /> Owner Mallinp Address City Zip Phone <br /> �__'.f�c��.�� ��Cl� �`U YiC!//.Y/7171 �lf�_`�'�'�.A f<4'/77�2'�.i'J <br /> Applicant Melling Address City Zip Ph na <br /> Describe Propoaed Work �E2�:SF_ Y-'�172KiAii �e✓,2C/��' 7 .���L /iff-7] T/�'E�I/L(Q,7U,�lS'"} <br /> ,Qcv.s� Sr,Q��-n�/�.�Z r� Bz��.o�-�,e 2- 2�s�- O,� Z�a < <br /> Pro�ect Addresa pf known) � � N � <br /> Altech four(4)coplea ol plane lor prnposed wo�h•Draw to scale and nota Ihe lollowing es epplicable: � <br /> • Property Linea • Cenlerline ol sireel � <br /> • Oulline and dimensions of all exiating end • Indicale North <br /> proposed atrutturea on Ihe lot • Show any proposed predir�p chenges <br /> • Exisling end proposed ulililiea • Show meesuremenla � <br /> DO NOT WR'�TE BELOW THIS LINE � O <br /> PERMIT CONDITIONS <br /> 1. A�I cells for inspectlon ehall be mada 24 his. in edvance�phone 258•8815. � <br /> 2. All work ehell be peAormed In eccordence wlth lhla permit enC cwrent Clty ol Everetl Design and Conslruclion <br /> Slenderds end SpecilicaUone. <br /> 3. Cell Locatlon Underground Service 48 h�s.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��.9?/.f/iil/� �EOT_ S/,iOVLt� $E �'oir�Y'F'rc�/�� O <br /> T/✓T T.r/6" E".t✓/ni•r.lr'•T<o� �F' Ts,�Fs�' P9.�',Ei•r/G �"� <br /> SPs,e'E.:S� /�� �'.e�,v� r,+.� .r.�eF.� oF � <br /> S�•9c'ES pir/ TisCr SiTE .a'E�a�-v T.vE �PEL�Ui,E�E.O O <br /> • •, -i�e i c � `YJiNiiY�U'�'J. � <br /> �O ��iG <�o�,�s �f',e��r ,�'q��.e�o /� �97 <br /> � ` <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The undersignad owne�/epplicant herehy epreea to hold ene save harm� <br /> less ihe Cily ol Everetl Irom any and ell claims lo� damegas, costs, <br /> expenses, m causes ol action Ihat may ariea beceuse ol instellaM1on <br /> and maintenance ol the improvement o� other righl�ol�way use hereto <br /> Approved foi Construc�ion pe�P applied for and lurther egrees to remove seme upon nolire from the <br /> Ciry an replece pu6lic property demaged thereby. <br /> � <br /> FINALINSPECTION Dele Z—�U � f, <br /> Approvetl es Consiructed 51 ature Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WURK AUTHORI2ED BV THI �PERMIT MUST BE STAFiTLD WITHIN <br /> � 3200 Cedar Slreet 1B0 DAYS OF DATE PERMIT tS ISSUED AND THEREAFTER IS TG <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259�BB1 5 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />