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/ �8t8--y.J�,{.p J PuppcWo�M�Permll• �S GIOD <br /> / / Appllcetion Fo� aieo o.o�-•_ <br /> PUBLIC WORKS PERMIT P�°;o,;;a.aFee . <br /> �� Leu�OP�Fea PUG { <br /> �I Print or Type Only esi���en�e • �2�— <br /> ` f a/O �F�- <br /> :; r� 79z.9a <br /> ����� �R � ,,��°����sy��r�� �-� -��9 y�> <br /> Ow e all�ng Atldreas Cily ip Phone <br /> i S.�-,�f e <br /> ! Applltent Malling Address City Zip Phona <br /> i Deecrlbe Prop eed Work ( < =--�W��K4�� <br /> � v <br /> i <br /> � <br /> i W <br /> iProlecl Addreae(II knownl ' . � <br /> � Attech fow(4)coplee ol plene lor proposed wo�k- Drew to ecele and note the lollowing es applicnble: � <br /> • Properry Llnes • Cen�erline ol streel � <br /> • Oulline pnd dimenaiona ol ell existing enrf • Indicate North <br /> proposed alructuree on Iha lot • Sl�ow eny proposad greding chanpes <br /> � Ezlatinp end propoeed utilitiea • Show measuremenls � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> i <br /> � PERMITCONDITIONS <br /> t. All cells for Inapection ahall be made 24 hrs. In advence•phone 259•881 5. � <br /> 2. All work ahell ba perlormed In eccordenca with thia permit and cu�rent Clly of Eve�etl Design end Conslructlon <br /> � Standarde and Specilicalione. <br /> � 3. Call Locatlon Unde�g�ound Service 48 hrs.6efore yo�diq.70LL FREE NUMBER 1•800•424•5555. � <br /> I � ��/UE'.0 71J BE 1>Gtn/E /'E.e .d/JO.�'o6f0 <br /> PGd�/S L�TEO 2-i.�'- 8S O <br /> .S /j.vy A�0.3/on/d[: E.Qos�on� co.vi,evG rv BE oO�.L� � <br /> P�T//E Pv�c/c G�b,e,�s ZNSP�tT.mlc'S ZivsT,c�v�TioN. � <br /> O <br /> � a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicant hereby agrees to hold end save harm- <br /> ��� �Q���, less the City of Everett irom any and ell clelms lor dameges, costs, <br /> / expenses, �r causes ol ection that may eriee becauae ol Instelletlon <br /> `�r.b �oa��� A/�ss end maintenance ol the Improvement or olher right-oFwey use hareto <br /> � �«t epplied lor and iwiher agrees to remove aeme upon notice 6om Ihe <br /> Approved lor Con�uc�io Date City end lo repleca pu61� property demeged thereby. <br /> �r1N�`'l 3,'`+' _� . - <br /> FINAL INSPECTION Date <br /> Approved as Conatructed Signeture ol Applic t Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUSi BE STARTED WITHIN <br /> � 3200 Cedar Slraet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 BE DILIGEN'fLV PURSUED f0 COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLEC BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJEC7 OVER 90 DAYS DURATION. <br />