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� Y� J ...+✓. <br /> o;i�—��::z._�`1 �,,,,�.�wo,,.�..,m, / <br /> APPI�r,ahen �m Nina Dno� • __��xJ� � <br /> PUBUC WORKS PERMI"f — -- - - -- <br /> 1'i�tilirWprMti!! � � � .. <br /> ir1e�I�n f . <br /> inu Anm �nn Pu� f <br /> Print or Type Only ���T������ s ��" _ <br /> �l�, 1 l(Zl.�`a''117 (��)2�t YL7� �s'7-�l' ?� <br /> Owner Madiny Atldress Cny 2�p Phone <br /> Applir,ent Meilmg Addre55 C�ty � Lp Phone <br /> l}�'r �- — Nns �� BF P,ovFi� <br /> �j' �.,�(� 1 , � /� P.ER P[qivNwvG <br /> Uescribe Proposed Work - � ���r" � � �L� ���1!'.�CC�'LGCa%. DEPT. _ <br /> l� <br /> Prolect Addrese Id knownl — ��I �, C� ��/-1� _ _ � <br /> � <br /> AtfeCh Ipw(4)copi85 0�p�9n5�o�prOp05ed work� Draw to sc�le antl nnle ihr lollowinp BS Bppliceble � <br /> • Property Llnes • Cente�line ol streel � <br /> • Outhne and dimeneions of ell e��sting nnd • Indicale North <br /> proposetl sln�cWres on the lol • Show eny p�oposed gradmg changes <br /> • EwiSImB and proposed utiiities • Show measuremenls � <br /> DJ NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls lor Inapectlon ehall be mad^24 hre.in advance-vhone 259•8810. � <br /> 2.All work ahell ba paAoimed in ecco�cence with thls permit enA current City of Everett Design and Construclion <br /> Stenderde end Specllications. � <br /> 3.Cell Locetlon Underground Service 48 hrs.betcre you dig TOLL FREE NUMBER 1•800•424•5555. � . <br /> O <br /> � <br /> � , <br /> O <br /> a '� <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The undersipned ownrtr/appi�cant heieUy ag�ees lo hold and save harm- <br /> -- ` lass the Cl�y ol Everell irom any nnd all claims lor damages. cosls <br /> / eapenses. or causes ol wcUon ihBl may Bnse beceuse of inslalletion <br /> , �, / !> r /` �7� �/�� anA mamlenenr,e o� Ihe improvemenl Or olher �ighbol-way use hereto <br /> L �->-" T� �/ applieA lor nmf lurthr.r ngrees to remove same upon nolice liom the <br /> Approved lor Conslruction / ��e City nnA lo repl�ce pu6hc property damagetl �hereby. <br /> ���`--�— ��-�'�' �� <br /> FINALINSPECTION Date ����" � �� / � <br /> Approved as COnslrut�ed G�gnaliue ol ApPhcanl D <br /> evrren PUBLIC VlORKS DEPARTMENT WORK AUTHOFIZED BY THIS � RMIT MUST BE STARtED ITHIN <br /> � 3200CetlnrStreat 180 DAVS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> Evera�L WA9B201 BE DIUGENTLV PURSUEi7 TO COMPIETION THIS PERMIT MAV BE <br /> Phone�.259�BB10 CANGELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON TMIS <br /> PROJ[CT OVER 90 DAVS DURATION <br />