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i <br /> � <br /> i <br /> � <br /> ,, <br /> � <br /> Date_ # n�a�ew.�n.�.,mn. � <br /> a APPlloetlon For B1ap.o�o� • <br /> � � RUBLIC WORKS PERMIT P�OTo1nF��F� : �o — <br /> � �...�oo�...o.w s__�— <br /> Print or Typa Only� 8 8 8 B�bnc�Du� s 3n � <br /> � � SMs � Co4'�� S�}3 -hZ3E <br /> w , �� E N � To;v ��a� �ox 9 sSSB Se I _W a SXIy 5 �3z-£�� <br /> � Owner a ��IHngAddress C�ty Zip Phanr <br /> � �� � <br /> W ��.�,�G �;� /1- 5 Aaov�. <br /> ApptiCenl MSllinp Adtl�eee Ciry Zip ?hone , <br /> . Deecrlbe Propoeed Work ��C S CW�� i �v 0.T �. Q {�.�vl�. a I I <br /> I-�n v� ar;���v�,. <br /> W <br /> Pro�ect Addreea(11 known) � <br /> Attach low�4)coD�ee of plena fo�proposed work•Drew to scale end note the following ae apPllcable: � ,, <br /> �, • Propehy Linea • Centedine of slreet /w ' <br /> � • Outllne and dimenalona of ell exiatlnp end • Intlicate Narth V1� '', <br /> propoeed structurea on tha lot • Show eny praponed qrading changea ' <br /> - • Exlatinp and propoeed utilitiee • Show meeturementa � � <br /> DO NOT Wf71TE BELOW THIS IINE o I <br /> I <br /> PERMIT CONOITIONS ' <br /> 1.All calla lor Inepectlon ahell be made 24 hn.in edvence-phone Q59•8810. � <br /> � 2.All work ehall be pedormed In eccordence wlth thle permit end cunent City ol Everett Deeipn entl Conatructlon ' <br /> Stenderde and Specillcatlona <br /> � 3.Call Lwatlon Underpround Service 48 hro.belore you dlq.TOLL FREE NUMBER 1•800�424•5585. �� � � <br /> �., /�✓ 5,�,,.f�1L �r� l��i��� �,,�o�o,,,,/ � <br /> // <br /> � '' <br /> � <br /> Q <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undarsignad owner/epplicant hereby agreea to hold and eave harm• <br /> , leea the City ol Everett Irom eny and all clalms lor damaqe0. cusla �, <br /> � . expenees, or causea ol action thet may edae becauee of Inntalleflon � <br /> � � „3 / antl mafntenance of the Improvement or other rlphbol•wry uee hereto � <br /> Appr r tructlon Date applled lor and lurther apreea to remove aame upon naliee Irom the ' <br /> . City end to replata public p�operty demeped thereby. <br /> A SPEC �t� �� /v��-�`� � . <br /> Approved B!COnit�uCted 3iynBturo 01 Appllt9n� Date '. <br /> PUBLIC WORK9 DEPAHTMENT WORK AUTHORIZED BY TH13 PERMIT MUST 8E STAR'ED�WITHIN ' <br /> 3200Ced�rStrs�t 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> Everott,WA BB201 BE DIUGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E , <br /> � Phona:258�BB10 CANCELLED BY THE CIN UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 OAYS UURATION. <br /> � <br /> i <br /> li <br />