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oate � /3 S� B6 —3fL/ <br /> v„oec wo�w�ae�mn• <br /> AppllCeliOn FOr BIUp DaD� • <br /> PUBLIC WORKS PERMIT Pu�Tot�fneFee � <br /> �����ool fea VUC s <br /> Print or Type Only e.�.���o�� s a� <br /> Ssvo,�v.K.sir wA. 9d as� <br /> ,D�vi,c� ,l���? S i y�2i - tH.av,7.�F �-g g_9 � 3G <br /> Owner Mailing Address City 2ip Phone <br /> SA-� /= <br /> Appllcant Mailing Atldress City Zip Phone <br /> Deeuibe Proposetl Work ( - �/�/�/ /� / /�/�j Q/— r�T��� S S!`f/�(�/�,S' /�j.y/,� �d JyG���—j�= <br /> /�/A� Ir'S A�y�� G�RR6�= J�LoaRS' <br /> � W <br /> Prolect Address�il Nnown) y e~ �R �Z �'�r�/' T% �/}�, s 9 U � <br /> Altach lam(4)copies ol plena lor proposod work-D�ew lo acele entl note Iha following as epplicable: � <br /> • Property Llnes • Canterlina ol streel � <br /> • Oufllne end dimenelons�1 all existing und � Intlicate Nor�h <br /> proposed elructurea on the lot • Show eny proposed preding rhanges <br /> � • Exieting and proponed ulllities • Show measurementa � ;i <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS I <br /> 1. All calls lor Inspection shell be made 24 hrs. in advence• phone 259•8815. � <br /> 2. All work shall be peAormad In accordance with thls permi�and current Clty ol Everett Design end Constru^.tlon <br /> Stenderde end Specilications. <br /> 3. Cell Locatlon Underground Sarvice 48 hra. balora you tlig.TOLL FREE NUMBER 1•600•424•5555. � <br /> � ,�EEr"' ST.fEE�� � �GLE�� �LEfi'.�9l13/6��:4pPM p0pqN1 � <br /> / <br /> �.C'FCiED �� C��T/ ��Z/�'l-�C 4-��'�e6T.�n s2o.o0 <br /> I S/'F�To.�' • <br /> t�ECK f2o.00 � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENi OF CONDITIONS <br /> The undersigned owner/applicant herPby agrees to hold and save harm- <br /> less Ihe Ci�y ol Everetl irom any and eli cleims lor damages, cosls, <br /> A�� J `D/3� expenses. or causes ol ection ihat mny arise because ol inetalletlon <br /> � and meintenance ol the improvement or olher righbol�way use, hereto <br /> ct+�z� J eppliod lor end luriner eprees lo remove seme upon notice Irom the <br /> Approvetl lar Con rut�l on �e Cily end to replace pu6lic property dameged Ihereby. <br /> ��� 6=.1i-fL 1�� � / � 0���/ S!` <br /> FINAL IMS�EC'fION Da�e ���tl <br /> Approved as Consiructed Signalu e ol Applicant Date <br /> evrrell PUBLIC WORKS DEPAR7�.9ENT WORK AUTHORI2ED BV THIS PERMIT MUST 8E STARTED WITNIN <br /> � 3200CedarStreet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA 98201 BE DIUGENTLV PUFSUED TO COMPIETION. THIS PERMIT MAV BE <br /> Phone: 259�8815 CANC:ELLED BY THE CIiY UPON ANV STOPPAGE UF WOPK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />