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,,,, _ <br /> oe�e 9� Q/pG ' r�ei�c Ho�w�varmn• _ <br /> ��� � 71�� <br /> qpplicetlon fo� eiev oao� • -� <br /> PUBLIC WORKS PERMIT P��I�cWork�fea -- <br /> tal�liee s— <br /> Leo�ppl ive PoiE � <br /> B��onca0ue { <br /> Print or Type Only <br /> _(= 7 r � e�,� / Oo3 � .N�.}} Q8� fa asd' -d30� —� <br /> Owner MeIIlnpAddress City Zip Ph�ne � ,,,�� <br /> ``wJ <br /> UQh�,q d- Sa rrova �d 6�ox3OCJ U r�Ti��' ,/S'/e�Tc� S��l� �ld'iD��7f <br /> Applicanl Meiling Address City Zip Phone <br /> Deecribe P�opoaed Work `� Yld�l.� ��XA�q % � 1°'��' ������� � <br /> � � � ,� ,A � <br /> --1� ,,, G,�g, '�a�� � — <br /> O <br /> P�olect Add�esa Qf known) aZ 7y .� Gl��f� n]1 i A j�_ � <br /> � <br /> Attech lour(4)copies ol plane for proposed work-Draw lo ecale and nate Ihe I011owing as appliceble: v <br /> • PropertY Llnes • Centerline ol streel � <br /> • Outllne and dimenslon9 0l ell e�iating and • Indicale North <br /> propo9ed Biruclures on the lot • Show eny proposed gretlinp chanpea <br /> • Exlsll�g end proposad utllltiea • Show meesurements � <br /> DO NOT WHITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells lor Inepectlon ahell ba mede 24 �•rs. In advence• phone 259•BB15. � <br /> 2. All work ahell be peilormed in accordence�vith thle permit end currant Cily of Everett Design end Conatruction <br /> Slanderde end Speclllcetione. <br /> 3. Cell Locatlon Underground Service 48 hra.Dalore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> / ��� <br /> � �FPGi'ti%� �✓OT' .�'e c��„eF_,D - � O <br /> � ���<<.� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT GF CQNDITIONS <br /> The undersigned awneqnpplicxnt heieby agrees lo hold and seve harm� <br /> less the City of Everett irom eny end all claime lor tlema�ea, cosls, <br /> eApenses, or causes ol ac�ion thet may eriee beceuse ol inslellalion <br /> and maintenencn of the improvement or other rlp�t-of�way use hereto <br /> applied lor end furlher egrees to remove seme upon notice Irom ihe <br /> Approved lor Conntr�ctlon �e�e Cily end lo replace public proparty damaged thereby. <br /> FINAL INSPECTION De�e <br /> Appraved es Construcled Signature ol Applicant Oate <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTNORIZED BY THIS PERMIT MUST BE STARTE[) WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTI:R IS TO <br /> � 3200 Cedar Streel BE DILIGE�lTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Evere�t,WA 98201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />