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� <br /> ,� <br /> D8�6�� !1 �� r�eu�woa.c.,mn. /y� <br /> BICp OeO� • �� ,�1�� • <br /> Applicatlon For "—I— <br /> PUBLIC WORKS PERMIT P�mKWorxefee <br /> iotei iee S <br /> � lees�OV� �eePsiE f <br /> Bei�nce Due f_ <br /> Print or Type Only <br /> i <br /> E IfY �� V 1k�,,.►c.� ��'�y Cpch!' E,.P,� 1�1.�'�0/ 2s�-4�F�`6 <br /> Owner Mailing Address City Lp Phore <br /> ��� � � <br /> � AOPlicanl Mailing Address City Lp Phone <br /> � DnsalbeProposedWmk F.,�,..�.;jy�� � /S��.NG l`�l�,fQ <br /> � <br /> ( <br /> ! �d�z�, I W <br /> Pro�ect Addresa Of known) �f C1(Q� � <br /> Attech four(4)copiea ol plans lor proposed wmk• Dievr to scale and note Ihe lotlowing as applicable: � <br /> • PropertY Linea • Cenlerline of atreef � <br /> • Oulline and dimensions ol ell exisling end • Indicete North <br /> proposed structuras on the lot • Show eny proposed grading chenges <br /> ! • Eelatinp end pmposed ulillties • Show measuremenls � . <br /> i <br /> I DO IJOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All celle lor Inspectlon ahell be mede 24 hn..in edvence•phone 259•8310. � <br /> 2.All work ehall be pedormed In eccordence with thie permlt end current Cfry ol Everett Dealgn end Conatructlon <br /> Standa�de end Speclficetlona. <br /> 3.Cell Locatlon Underpround Service 48 hro.before you dip.TOLL FREE NUMBER 1•800•424•5555. � <br /> �� �r� /��/�-C . t� -Z 2-�B � <br /> � � � �� � <br /> � <br /> O <br /> a <br /> jACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/apUlicanl hereby egrees to hold and eave harm- <br /> — leas Ihe City of Everett Irom eny and ell cleims lor demegas, costs, <br /> ezpenses, or ceuses oi ection Ihal mey arlsa because ol Installalion <br /> antl maintenence ol Ihe improvement or o�her righl�ol�wey use hereto <br /> applied lor and lurlher agrees ta remove sema upon notice Irom the <br /> � Approved lor Conslructlon Dete City end lo replpce pu66c property dameged thereby. <br /> I <br />�� FINAL INSPECTION Dete <br />�� Approved es ConsVucted SignaWre ol Applicant Oate <br /> WORK AUTHORIZED BY TNIS PEflM1T MUST BE STARTED WIiHIN <br />��� e�erett PUBLIC WORKS DEPARTMENT 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br />'��� 3200 Ceder Slreet <br /> Everell,WA BA201 BE DILIGENTLY PURSUED TO COMPLE�ION. THIS PEFMIT MAV BE <br /> Phone�.259�8810 CANCELLED BY?HE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> I AROJECT OVER 90 DAVS DURATION <br /> I _—___.. ___. ._ _ . __ _ __._._. __ . _. ____ <br />