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i' � � <br /> 1�'n�e / �� ' Pun�¢Wb �ePermp• X� — /_.' <br /> Appllcatlon For Bmy Deoi •� y <br /> PUBLIC WORKS PERMIT PaE1lcWorbFes <br /> Tol�i F�e f ,, <br /> La���o�i.Fee Peia � ��� <br /> Print or Type Only a.�.��so�. • /���-'.' — <br /> - -•C�_-a��T �i'r.���r /,�; N�.r /'�5�6 F-�;�[� <<,:4 �a c� <br /> Owner Melhng Add�ess Clly Zip Phone <br /> -slJ/� f- <br /> Applicenl Meiling Addresa City Zip Phona <br /> Daecribe Propoeed Work _ �ri!'STf'c�� T Q /�1� l/A%.'T A�,e,('Tn+F.c.'" <br /> fic ic Oi.�-c�.. <br /> P�o�ect Addreae Qf known) �'�'-�'— I�� �ASi�.E7 iCO � <br /> Attach lour(4)coplae of plene lor propoaed wo�k• Orew to ecele end note the I011owing as applicable: � <br /> • Proparty Linea • Centerline of etreet � <br /> • Outllne end dimenelone ol ell existing and • Indicete North <br /> propoeed ntructuree on the lot • Show eny proposad greding changes <br /> • Exleting end proposed utililiea • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells lor Inepectlon shall be mede 24 hrs. In advence- phone 259•88�5. � <br /> 2. All wa�k ehell be pertormad in eccordence with thia permit end cunant City ol Everett Design and Conetruction <br /> Stenderda end Specllicatlons <br /> 3. Cell Location Underground Sarvice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � %i/�S SiTF /N�u:C T B! ('Cu�:.c't.tTF� � �E.�' O <br /> AP/3t'�'re� �'l�1��S G2o7z-1� �t' �-,5'> , <br /> J I�"L'lT A�'U/.ac:E' � <br /> �. y� f�iit'd.tlT Es�.S'finc.dT <br /> �l:E' f7.i'iJiNil6f'� S(/STFi•� �it� i�/Je: F� L�f/'/, fF7Y��i.'� � <br /> / <br /> � Qf�!>�f� ����� ���� /.J� lw_i�Lcf L�„ <br /> O <br /> a <br /> PGKNOWLEDGEMENT OF CONDITIONS <br /> The undersigneC owner/apPlicenl hereby agrees to hold end eeve harm- <br /> les; the City ol Everelt irom eny end all clahns for dameges, costs, <br /> v, , , e�penses, or causos ot action ihet mPy Brlst 68Ceusu ol Inetallation <br /> r � /� end maintenacce ol Ihe im rovement or othe�ri hFol�wS uee herelo <br /> —������� "'''—� /� —� ���' epplied for end luriher agrees to remove same upon not ce Irom Ihe <br /> Approved lor C/�al�u tlon Dete City and lo replace public property tlemnged ihereby. <br /> l.J`� � �pS�,/� �— _ ` - l i i <br /> FN.4L INBPECTWN � Dete �' � ����� - �� � <br /> Abroved es Conslructed S gna r o Applicent � <br /> rIveretl PUBLIC WORKS DEPARTMENT RK A T ORIZED BY THIS PERMIT MUST eE STARTED WItHIN <br /> � 3200CederS�rea� iB DAY9-OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � Evare�t,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAV BE <br /> Phone: 259�BB15 CANCELLED BY THE CITV UPON ANV SfOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />