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oa�e_� �,e�k�,..�.,�M. / 2ti.� J . <br /> Appllcalion For eao o.n.• <br /> PUBUC WORKS PERMIT �e1kWa�.F» <br /> .o�.�F.. • �. <br /> lo��ppl FN P�q i_ . <br /> Print or Type Oniy <br /> T� POSTIN6� ° 5 2001 b�I�nc�Dua { FoG" TC Hc <br /> �'o�P�/�U <br /> Ld/CiC. <br /> //l=° a��i.�� Co. %�Cf�nX ,�;n7 �/SnF_7� S�rYzE� c�/n /2y-?X�7 .JY2-547f7 <br /> O� MaiHng Addreee Cfly 21p Phone <br /> nc�iac� <br /> Applicent I�alting Addreee City Zip Phone <br /> Deecrlbe Propoeed Work Ti7Sta l� �/�vi�qa� �� r rr� q�fy�v f�.•��os <br /> 5�0,4� _��-s3� ,. S�n-b'2- _ <br /> Pro�ect Addresa(11 known) 3�%3- ��� C4S iilU O� � <br /> Altech lour(4)coplee ol plene for proposed work• Diew to ecele end note Ihe Iollowinp ee eppllceble: � <br /> • P�opeAy Linee • Centedine ol sheal <br /> • Outlina ani dimenalone ol ell exlellnp end • Indicele Nohh N�� <br /> p�opoeed slruclu�ee on Ihe lot • Show any propoeed prading changas <br /> • EMislinp end propoeed utiHtles • Show meaeuramenle � <br /> DO NOT WRITE BEL W THIS LINE O <br /> PERMIT CONDITIONS <br /> t.Au cane lor�nspacnon ehan be mede 24 hn.�n advence•phone 269-9B10. � <br /> 2.All wo�k ehell be peAormed In accordence wlth ihia permlt end curranl Clly of Everett Deaipn end Conetructlon <br /> Stande�de end 3peclllcetlonn. <br /> 3.Cell Locetlon Underpround 8arvlce 48 hre.before you dlp.TOLL FIIEE NUMeEII 1•800�4Z4-aSbS. � <br /> � lti���,f fc 6 c d,nc ,G�?r �O�n f a��ir✓t'c� oi1 7-��-9/ O <br /> /�y �/�� e�%�i-�7Y /-�:/!,� ld�r.fS A�f. <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undarelgned owner/epplicant hernby aprees lo hold end eave harm- <br /> leae the Cfty ol Everetl Irom any and ell claima lor demapea costq <br /> � _— • expennes, or caueee ol action thet mey eriee because ol Inalalletion <br /> � =� /�� // end melntenence ol the Improvement or other rlghPobway uae hereto <br /> applled �or and lurther aqreee lo �amove eeme upon notice from the <br /> Approve or st�uction � - ate City end to replece public propehy dameped Iheraby. <br /> l /� ' 7� � �J/9 <br /> FI AL 5 E ION � � � � Dele !�� ��-����� I` � ? �� ✓ <br /> Appioved as Conatructed Sipnetu of Appllcent Dete <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MU4T BE STAHTED WITHIN <br /> 3:OOCeder3lreet 180 DAVS OF DATE PERMIT IS ISSUED AND TIiEREAFTER 13 TO <br /> Everot4 WA9B201 8E DILIGENTLV PUR3UED TO COMPLETION. THIS PERMIT MA'I BE <br /> Phone:26B•BB10 CANCELLED BY THE CITY UPON ANV STOPPAOE OF WORK ON 7HI3 <br /> PFOJECT OVER 9�DAVS DURATION. <br />