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,`l � � �' r �.. i_ � . :�_ :i'/ <br /> ?4 f <br /> K <br /> Date�?� 9 1i �„���,���o�.�.,m�. —��-�� --- <br /> . � mno o..� . --- <br /> APPhr,2tionFnr --- ---�-----�--� <br /> PUBLIC WORK�PERMIT ��°;�„��;��- s_ --- — <br /> � �ov�noi rne ve�a S <br /> Print or Type Only S S n+�.��.n�� s '��� _ <br /> � � � <br /> �� u � �r�ncene 3 �3 � ~ C ,d� �- S7� <br /> p�y�e� Maihng AA �54 ,,, �y � City 7ip Phone <br /> Dn � u �4A � C.. � �� ��.5 7�'/��.C}c �i_ `t�Z o�F 3S3 � 9`I�c <br /> AppliCe i Mniling AAdirss Ciry Z�p phone <br /> Describe Proposed Work � n S*A �"( �����+ !-7 N� RZ _ <br /> A W <br /> Prolect Addrese lil knownl 3/3/ (�I�ani.e .ST � <br /> Attech lour(41 copies o�plans lor proposed worM� Draw to scale and note ihe followmg ns apPlicable. � <br /> • Property Lines • Cenlerfine of street � <br /> � Outllne and dimensions ol all ezlshng and • Indir.ate North <br /> proposed StruCtures on ihe lot • Show eny p�oposed gradin� c�ang�s <br /> • Ezisting and pwpo.ad utildies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cells lor Inspectlon ehell be made 24 h�s.In advence•phone 259•881 O. � <br /> 2.All work ahell 6e peAormed in eccordance with Ihis permit end current City of Everett Desipn end Constructlon <br /> Standerds end Specilicatlons. <br /> 3.Cell Location Unde�ground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � /itJp,¢�t TO B�" UONF P,c.Q APo,�ouF_D S�c�rcN O <br /> vArEo 3 -i�- 89. <br /> � <br /> � <br /> O <br /> a <br /> �CKNOWLFOGEMCNT OF CONDITIONS <br /> Thi�unCnrsign�A owner/xpphcant hereby agiees to hold anA save harm� <br /> — less thn Cdy ol Everett Irom pny and all daims lo� Aamages. cosis. <br /> / e�penses. or causes ol action that may anse becauso ol in5talln�ion <br /> �_��+'„�C/ � ���9 and mamtenance oi the impiovemenl or other nghl�ol�waY use hereto <br /> npphed for and lurther agrees to remove same upon noUce hpm ihe <br /> Approved lor Cons ction � Date Ctly anA to re ar.e Uhc nronery�damaged thereby. <br /> �� � r i-Fj <br /> FT AL INSPECTION Dalc �— <br /> Approvetl as Constructed Si9 Wr. ol pphcanl �� e <br /> everrtt PUBLICWORKSDEPARTMENT WORK AU HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Ceder5lreet 180 DAY OF DAiE PL"RMIT IS ISSUED AND THEREAFTER IS TO <br /> Eve�e1L WA99201 BE DILIG �NTL1' PURSUED TO COMPLETION THIS PERMIT MAV BE <br /> Phone�.25P-BB10 CANCELLED �V THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OV[R 90 DAVS DUPATION <br />