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/ . <br />�.. :. . .'_"_'— <br />�„_"," ....., <br /> � I PON.:"worbPermO• `�`�' _�/I <br /> �818_S� � Bmp Deo� • <br /> Application For <br /> PUBLIC WORKS PERMIT °"°"""°".`°° ,� =� _ <br /> tal�l Poe s �_� <br /> Leu�OD� Fee PnU f <br /> ��+ �� <br /> B�I�nce Due S�---- <br /> Print or Type Only �'j,(',�F,�sE-✓.s-�asa - y.j`�� <br /> ,/ l h✓/�i lr - ' / O�IE. <br />` Odr �+t vfF� �f b2�/ 1 �9- 1Z7Z <br /> ��11� /I �f_%1 C_ e/L�AI' t vCYC / � � Phone <br />' Mei.snq Atldress Ciry Zip <br /> Ow ar <br />, SRM� <br /> ,S�n�_�--�` CitY Zip Phone <br /> Appllcanl Melling Addresa <br /> uaB��mae���aheawo�k I��/.f< <x �s7`",�i sid[ WA��4 �•a�• ,•� T � f L/�.i�c /1 <br />' W <br /> _ � <br /> s6� � �. d�r <br />� Pro�ecl Addreea UI known) -- <br /> � <br />' Atlech lour 14)coplea cl plane�or propoaed work• Draw to ecale end nole Iha lollowfng as applicable: � <br />�� • ProparlY Linea • Centerline of street <br /> • Outlino and dimensions o1 ell exislin;,n��� • Indicete North <br /> proposed structurea on Ihe lot • Show any Proposed grading changes <br /> • Exleting nnd proposed utilities • Show meesurementa M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS 259•881 S. ' <br /> 1. All celie lor inapection ahall be meda 24 hrs. In edvance- phone <br /> 2. All wark shall be perlormed In accordance with thia permit end c�nrenl City ol Everett Design end Construction <br /> Slanderde end Specillcations � <br /> 3. Call Location Unde�pround Service 4B hrs. before you dig.TOLL FREE NUkIBER 1•800•424-5555. <br /> [�. �}\� /Cw��] �/�� rwK) � bt i4w1 � G� .\� ftMOJ/�/ � � <br /> hCA.�fC�' CT�awi�ew ,O�w� <br /> $'. Gr..�e y...1aa �-+ < a.�pro.r..� V-1 P.w. S,�.s �► te_J-e� � <br /> 'f�or � �JOu� �w` v�tw CO.ntfG�, � <br /> J <br /> 10/O6/86 9�23AM OOOHM2 � <br /> � a <br /> oPr.zo s2o.00 <br /> casf+ s�o.00 <br /> ACHNOWLEDGEMENT OF CONPITIONS <br /> The undersigned owner/epplicert hereby egrees to hold and seve horn� <br /> less the CiIY ul Everett Irom eny end ell clelms for damages, cos�s, <br /> ezpenses, or ceuses ol ection Ih3t may eriae because ol instellnlion <br /> ���-�� �� . q �. � and maintenence ol Iho improvemAnt or other righDol-way use he.reto <br /> epplied lar end lurther agrees �o �emove aeme upon nolice iram Ihe <br /> A oved ibr CoM� i c�ie� / -� - Dete City end to replace public property dameged thereby. <br /> � / /��t� ir�_/7.fG � i� /11v[ � <br /> INAL INSPECTION Dale Dete <br /> Approved es Conslrucled Sign tura ol App icant <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everen PUDLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Slreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PEPMIT MAV BE <br /> Evr.ratl.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF K'CRK ON THIS <br /> Phone� ?�i9��B15 pROJECT OVER 90 DAVS DURATION. <br />