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�8�f� Pum�c Worw�Pnrmn. S .1�� <br /> AppllceGon For Bmc oeo� •� � s S�7 <br /> PUBLIC WORKS PERMIT P��LCWorY�iee <br /> Talel Fee � __ <br /> Les��DG��ee Ye�J S <br /> Print or Type Only ee�ence�ue 8,���_ <br /> �/ 000 <br /> /�/=.LbN �J��i✓�✓ //>oa �; l�E.v.,i.:� c✓qy �1ati�o._ 5�.��z �yy- ��yo <br /> Oh�ner Mailing Address City Zlp Phone = <br /> 0 <br /> �7 -�1 <br /> �/7�� /�S /��Cd[.: m <br /> Appllcenl Melling Addresa City 21p Phona � <br /> Deecriba Propoeed Work �iYSTvc T Si,�jlit� �aw/,'.�.( � � <br /> ..� � <br /> N S <br /> — c <br /> m <br /> co <br /> mo <br /> n <br /> o � <br /> Projecl Addiaea(il known) �.%��oL C�(9l' .S%� _ _ � � � <br /> Attech lour(4)coplea of plena Im proposed work- Draw to scale end note Ihe�ollowing eis applicable: r Q = <br /> c <br /> • Pro,�erty Lines • Centerlina cf slreet ' � <br /> • Oudlna end dlmanaions of all ezisting and 11 Indicele Norih � .r-� � <br /> ro osad alructures on the lot • Show an '"� � <br /> P P y proposed grading chnnges K <br /> • Exlsling end proposed u�ilities • Show measurements � A <br /> DO NOT WRITE BELOW THIS LINE O —1 � <br /> PERMIT CONDITIONS m� <br /> 0 <br /> 1. A l l ce l ls for Inspec�lon s he ll bn mede 24 h�s.in ndvance-pnone 2 S 9•B B l 5. � p m <br /> 2. All work shall be perlormed In xccordence with this permit and current City ol Everelt Design nnd Consiruction � N <br /> Sfandards and Specl�icatione. 3 V� � <br /> 3. Gell Locallon Underaround Service 48 hrs. belo�e you dig.TOLL FREE NUMBER 1•BOO•42O•SSS5. � z C'i <br /> � m <br /> a <br /> O A <br /> x <br /> a <br /> z <br /> � � <br /> � <br /> � � <br /> z <br /> O o ' <br /> � <br /> .. <br /> n � <br /> � m <br /> ACKNOWLEDGEMFIJT OF CONDIIION:B I <br /> The Undersi{�rod ownP,r/eppliCAn�hereby xyrees lo holA nnd save hnrm� <br /> �G7 1S,�S less ihe City of [vereU Irom any ond all clalms lor tlemnges. cosis. <br /> J expenses, or cHuses ol action Ihet mny n�ise beceuse ol inslallalion <br /> � end maintenance ol the Imp�ovemenl or other righPol�wey use heralo <br /> ��� 'a ��' epplied for and furtYer agrees to remove same upon notice Irom the <br /> prove or struction � / ' D� Ci�Y ond lo rePlr�ce Vublir.P�Pe�IY damn9ed Ihereby. <br /> � ���C�l t� o� -3 -�� �j [� ��,: � <br /> F SPEC 10 Dute C f-�r_-,1 � /�I�LC�'��l�.f� �C� �•��%'�I � <br /> Approved xs Construcled Si< aWre ol Applicenl Date I <br /> rveretl PUBLIC WOFNS DEPARTMENT WORK AUTHORIZ6D BV THIS PER 1 MUST BE STARTED WIiHIN , <br /> � 3200CederStreet 1B0 DAYS OF DF,TE PFRMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everett.WA 98201 BF DIUGENTLV PURSUED TO COMPLETION IHIS PERMIT MAY BE � <br /> Phone� 259�AB15 CANCELLED B\'THE CITV UPON ANV STOPP�GE OF WORK ON THIS <br /> PROJECT OVEq gp DAVS �UPA710N I <br />