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�' 2Yn � <br /> I`iei�m Wor�.�Pnrmil• . <br /> Date�--�-- mav osni •_______-�-. <br /> qpplice�ion Fo� _ <br /> PUBLIC WORKS PERMIT �"°',�'"��:`°° s <br /> leff�o�� RePei� s ---- <br /> a��-( ,' "_—. <br /> eeienre�ue — - <br /> Print or Type Only <br /> /;i� di'�,i .; .', : /�'.5' ^f.- / (..;.f/(r !< <� `�6'%7Y� 11t: 7 I• ( - � i : <br /> �/" � /��', � (�G. PhOne <br /> Owner �: � Mailing Atldress GIY ZiP , .�., <br /> ('r.. r, �i � � .. . Phone -- <br /> Applicant Meilinq Address C��Y Z�p <br /> j t ��� i�i %� % �r�c.' ' 1c 4�i�1� ���. Noi-t/ C'r+n��-�l�k _ <br /> Descriho Proposed WorM. <br /> � ' �t��o� �in n � �h�•o �<-/���/ <br /> .f.�c i. � r l�'� . .,C �iCi� �,f sS'�'SLt.i� /�l i'if s-� .��—_"'7 <br /> �r i , .i qi�,'« <2r7c/ <'cnn^c' oi �n c{ �, �i� c/ T��' <br /> --y- W <br /> Proiect Address Ui known) <br /> -. � ; - 4.� �--,1-,,,� � .r t� � <br /> � <br /> AOach four(4)cop�es ol plens lor proposed work� Drew to scaie and nole the lollowing as applicnble � <br /> • Properly Lines • Centerline of street <br /> • Outline end dime�5ion5 of all ezisling enA • Indicn�e Nurih <br /> proposed sirueW res on the lol • Show any proposed grad�np chanyes <br /> • Existiny and proposed ulilities • Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> t.All calls br inspeclion shall be mede 24 hrs.in edvence- phone 259•8810. <br /> 2.All work ahall ba pedormed in eccordence with lhls permi�and current Gry of Everett Dosign end Construction <br /> Slend.rds end Specllicetions. � <br /> 3.Cell Locetlon Undergwund Servlca 4B hrs.bebre you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> `/, � ,i�/ f.� �' . /�� ,. �) •i /�1.:�� ,S�j:�c.I� ,� /j, �i [ �/f/ � <br /> , ., j �� . . . . ,�' , ,-i� ' ����, �, .," .�+'��:'/ <br /> ,' � , , . , . . � � <br /> � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> Th��imders�9neA owner/app�icant hereby B9�ees�0 holA end savrt hnrm <br /> �--�� � � -� - ��� i��;s the Cily ol Everell I�om any and nll r,laims for damages r.o:�•ts <br /> � ,_- � nxpenses. or causes ol xction Ihat mny erise because o� mstaU;Uon <br /> �� � and maintenanr,e of the improvement or other rio�l�ol-wey use herelu <br /> �/ / � / ��� npplied for nnd luriher agrecs lo remove same dpon notice Irom Ine <br /> ApProv ..�� � -� � Dale CitY and to�ePlsc uhlic Property damaBed therebY. <br /> A� �� Q? �, I,�"Yl(��,�fi�^��• � � y( — <br /> FIN L INSPECTION Date � Date <br /> Signat ol Applicant <br /> Hpproved es ConslructeA <br /> WORK AUTHORIZED BY THIS PERMIT MUST 9E STARTED WITHI <br /> �-� PUBLIC WORKS DEPARTMENT iB0 DAYS OF DATE PEPMIT IS ISSl1ED AND THEREAFTER IS TO <br /> � 3200Ceder Slreol B[ DILIG[N7LY PURSUED TO COMPLETIUN. THIS PERMIT IAAY BE <br /> Evere�l WA9�20� (�.nyCLU.ED P,V TH[ CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phone-259�8P10 � PH[tll Cf �)VLH �ul f14VS IIUR!lu�rl <br />