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i' <br /> DB�e�� __ tI PUELc Worh�Parm�l� __j[!� <br /> Appllcallon For D � � � � �1 � D eieo oaot • <br /> PUBLIC WORKS �F��IT'/ P����cWorw�fae <br /> C 1 1 J J(� Tol�l Fe� { <br /> TO POSTING �f �...�oPIFeePeiJ ���/� L <br /> ' ��1—l� ... ._.....,___...._.._............. Balencn0ue � �ll/Z �O, <br /> Print :,r Type Only �;�� � (1F EVERETT <br /> ���g. Parmit Counter <br /> �RD �aarNF�s 659 .�rusKLESHooTGRcc� L�¢C'oNl�bR ,,,t} 9B2S7 466-5� <br /> Owner Meiling Address City Zlp Fhone <br /> ZsB"Q��B <br /> HAieDr ��Nc�i� ��i4- �B�`'`�Z N,td,�� ��- �Bz�a � �sZ"9673 . <br /> Applicanl Mafling Address Clty Zip �p <br /> Deacrlbe Praposed Work <br /> �R��/�MEn�Ts �2 Ln.r.� , <br /> Pro�ect Addreea�il known� �TJR7�D �/�STOF ��F�,ON 72D Q�L[�1[y(��, � <br /> Attach lour(4)coplea of plens lor propoead work- Drew to acele and note the lollowing as applicable: � <br /> • Property Linee • Centerline ol street � <br /> • Oulline and dimenslone ol ell exieling and • Indicele Norlh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exlsting and propoaed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONOITIONS <br /> 1.A��cells for�napect�on eha��be mede 2a hre.�n advance•phone 259�8810. � <br /> 2.All work ehell be peAormad In eccordance with thla permit end curient City ol Eve�ett Dealgn end Canatructlon <br /> Standards end Specillcetione. <br /> 3.Call Locatlon Underpround Servlce 48 hre.belo�e you dlg.TOLL FREE NUMBEq 1-800�4245556. � <br /> � �.�- �.���o.� �i� s-2o- 9 f O <br /> Ob/17/94 8�49NM OOONM561 � <br /> / � <br /> M00094181 <br /> DPT.20 f76.00 O <br /> PY/PC t1S3.�0 <br /> �� .��.� a <br /> �� ,��.� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owne�/applicent hereby aBreea to hold and save harm- <br /> � less the City o� Everetl Irom any end ell clalma lor dameges, coats, <br /> ezpenses. or causee ol eclion Ihat may arise 6eCeuee ol Inslelletion <br /> end meintenance o improvement or other�ight•ol•wey uae ha�elo <br /> epplied lo� and 1 ther agrees lo remove seme upon notice Irom the <br /> roved struction ale G� a d to re la <br /> y p p lic proper�y dameBed Ihereby. <br /> FINAL INSPECTIO Dat � �' <br /> Approvad es Constructed Slgn re of Applicant Dale <br /> � PUBLIC WORKSDEPARTMENT WONK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> 3200CedarSireet 180 D.4YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA BB201 BE DILIGENiLV PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phona:259�BB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION <br />