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� <br /> r ' <br /> Date �- �°'1`I Pu�bc WorF�Permn• ��_ � _ <br /> AppliCetlon For eiac oao�.•��1.�s.� <br /> ; PUBLIC WORKS PERMIT '°°:o,:FeeFae � 3,g, �,� <br /> Le�+�oo� F��Putl d <br /> ' B�i�nc�Due a '3 3 �r-�3� _ <br /> Print or Type Only ���,9 <br /> I ' !� nJ • ' <br /> �rl�uc� 4p w�.t�. �Wt 11�y E I.QSI n� F4 E�C� �7�f–� �`!�� <br /> Owner Mailing Address City Zip Phone <br /> ! �oK.�.l�{ ���•Q�,,. Co�- /5� Fc �as�.,o E�.r�r�V�' 9dioS� 77y- avQ� <br /> Appticant Mellinq Address Cify Zlp Phona <br /> OB9criba Proposed 1York ��k�" S� I C e�'�'� W/ �u'� I� w�^^� <br /> 1 VN.�/"O d C 1M T— <br /> 1 <br /> I _ <br /> � � � s � . CQ5 ',� o Q W <br /> Pro�ect Addreee(il known) — � <br /> Altath lour(4)copies ol plene lor p�oposed wak� Drew lo scale and note ihe lollowin9 as epplica6le: � <br /> • Proper�y Linxa • Centerline o�slreel � <br /> • Oulline end dlmanslona of ell exietlng end • tndicate Nerth <br /> proposed strucmrea on tha lot • Show any proposed groding changes <br /> • Existing Bnd prcpoead utllitlea • Show measurements � <br /> UO NOT WRITE BEIOW THIS LINE . O <br /> PERMIT CONDITIONS <br /> � 1. All celle fo�inspectlon ahell be mede 24 hra. in edvance- phone 259•88�5. � <br /> 2. All work ehell be perlormed In eccordence with ihis permit and current Cily ol Eoeretl Desiqn nnd Construdion <br /> Slendards end Speciilcetlons. <br /> 3. Cell Locelion UnderBround Service 4B hrs. 6efore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> a/ �C!'�la� v�ti-w�n�2 � �dC'� rl wi t� N��.tS 1-- b� Gy E(\V!��✓ <br /> � <br /> � �v Q�.bl � w o�c s i-: t R.....JNw� . � <br /> i /7 �. <br /> ; -� tl � � � . b � P�,�� � �-,�- �-{ o� .� -�-ro � �' <br /> �.+ 011� ao��j L rc w�, l l. h� Pl a.c e o... V+�� �v'OJ Q <br /> I O <br /> � <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The unde�slgned owner/applicanl hereby aBroes lo hold entl seve herm- <br /> � - lass Ihe City ol Everolt Irom eny end nll cleims lor dameges, costs, <br /> e�penses. oi ceuseo of ection Ihet may ailse beceusa of Instellatlon <br /> /�V_ � ,i and mamtenence of ihe imp�avament or olhei righ��of�way use hereto <br /> �� applied lor end luriher egrees lo remova same upon nolice from Ihe <br /> o Con truction �B�e Ci�y end�o replace public propnrly damegeA �hereby. <br /> � r � � ' 4 <br /> F A N P CTIO B�e — <br /> Approved es Cons u ted Signe ure of Applicanl �e� <br /> everetl PUBL WOHKS D�PARTMENT WORK AUTHONIZED BV THI PERMIT MUST BE 57ARTED WITHIN <br /> IBO DAYS OF DAiE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE UILIGENTLY PURSUED TO COMPLETIO�J. THIS PERMIT MAY BF_ <br /> Everetl,WA 98201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone�. 259-A815 PqOJECT OVER 90 DAYS DURATION. <br /> � <br /> I - <br />