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D8t@ `�� � Pa�bcWorksPermil• LV^ ~ <br /> ApPlicetlon FO� 6ley Deol.� <br /> PUBLIC WORKS PERMIT Puelot�FeeFee s_ �� � <br /> le�!�Cpl Fee Pe�O S <br /> Print or Type Only Pelence Due .S Z� <br /> �^,/AA �T7 C �-�I� �i��'� r�� � i�� `j G�C� � o'����1i1� <br /> ow�er �"'�1"a` <br /> MallingAddress City Zip Phone <br /> �'Yl' Y"YI� <br /> App icent Mailinp Adtlress Cily Zip Phone <br /> Desalbe Proposed Work _ ���� � �/ � ���� l �V� <br /> Project Addresa(II known) _ .3.3���— Cf.�7L' .S T � <br /> Altach lour(4)coples ol plans lor proposed wo�k- Draw lo acale and note Ihe lollowing es epplicable: <br /> i <br /> � Properry Llnes � <br /> • Cenlerline of s�reet � <br /> • Outllne and dimensions ol all exlatinq and • Indicate North <br /> propoaed siructures on Ihe lot • Show any proposed grading chenges <br /> • Exlsling end proposed utilitias • Show measurertienls <br /> DO NOT WRITF BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All celle lor Inspaclion ehell ba meda 24 hrs. in advence� phone ?.59•8815. <br /> 2. All work ehell be perlormed In accordance rvith Ihis permrt and current City of Everetl Design and Construclion ' <br /> Stenderda and Specilicatlons. <br /> 3. Call Locelion Underpround Service 48 hre.belore you tlig. TOLL FREE NUMBER 7-800•424•5555. <br /> '� ��- a�pvw.ed ��+s 4�'�2 7 -23 -Fh J Z <br /> / O <br /> � <br /> � <br /> O <br /> a : <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � <br /> . The undersigned owner/epplicent hereby ng�eea to hold r,nd seve harm- <br /> �—. __, _ less the Ci!y ol Everett Irom eny and ell claims lor npmag�s, coste, <br /> �J�: y expenses, or causes ol action that may a�ise becau:e of instullelion <br /> / ��Z��d/ ^d meinlena e � the improvemen� or other righ��of wey usu herato <br /> App�ova lor �onsln n 0ate a lietl lor antl urt i egroes to remove seme upon nollce Irom the <br /> Cit end to replac ic prope�ty demnged fheraby. <br />_ �, o d�s-F ) G??? <br />°INAL INSPEC.ION Dale ' �` G� <br /> lpproved ea Construc�ed Sig ture ol App icant Onte <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUS7 BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAVS Of OATE PERMIT IS ISSUED AND TNEREAFTEP IS TO <br /> Everetl,WA 98201 BE DILIGEMl V PURSUED TO COMPLETION. 'i HLi PERMIT MAV AE <br /> Phone: 259�881 F CANCELLEU BV THE CITV UPOIV ANV STOPPAGE OF�JORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />