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i <br /> � <br /> k G� - 'L9-Z9-S _ <br /> oR►e�?��� qo ��a <br /> PuUi¢WorM�Perm/�• <br /> � <br /> , A�1pIICB1100 FOf Biap Depl • <br /> PU�LIC WORKS PERMIT PuEimWorh^Iee — <br /> Toulfe ` <br /> Le���ppl Fee V�id S <br /> � � � � � G�Z03 <br /> B�IenuOue S <br /> � Print or Type OnlyQ=� � — <br /> �f N' 00 � <br /> .+ ('J <br /> M N .�+ <br /> " " �:� i a5a�a�a <br /> ¢ wner � r. � tde�lling Addresa City Lp Phone <br /> 1 s � � � u <br /> t qpplicent Maifing Add�ess City Lp Phone <br />� k �6� /17-/�� <br /> � Dencriba Propoeed Work � � �� <br />�_. <br /> s <br />:y:. <br />�1 ! <br /> ' - W; , <br /> � Pro�ect Add�eee III known) 331 q G��-. ST _ � <br /> . Attech fow(4)copf88 ot plens lor proposed work-Draw lo scele and note the following es epplicable�. � �i <br /> t • Property Llnas • Center�ine ol streel � i <br /> ` • Outlina end dimensions ol ell exisling and • Indicale North <br /> iproDoaed 6iructurea on the lol • Show xny proposed yrnding changes <br /> ' • EMlstinp and prOposed utllities • Show measurementa � <br />: � DO NOT WRITE BELOW THIS LINE <br />,� � � �I <br />;;�, PERMITCOiIDITIONS <br /> 1.All cells for I�apedion ehall be mede 24 hia.in edvence•phone 259•8810. � �I <br />�,. 2.All work ahaL ba poAormed In eccordenca with thla permlt and cwrent City ol Everett Design and Conalruction <br /> � Stendardea�iSpecillcetlona. <br /> I, 3.Cell Locallon 1�nderpround Service 48 hra.before you dip,TOLL FREE NUMBER 1•800�424•5555. � III <br /> i <br /> j � �l. .��.� .t�. �� d��. �ti, �,.��.w_ �����-, ,r/� O <br /> Ot� �.f��t.�lwlurz/� ��� mv 7-/�-%o <br /> ��''«�G c�iM� rn�C�, � I <br /> � i <br /> � O I <br /> ; a <br /> ! ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/epplican�hereby agrees�o hold end save harm- , <br /> I less the City of Everelt Irom eny end ell cleims lo� damages, cosls. � <br /> � expenses, or causes of action thal may eriae baceuse ol inslallalion '� <br /> ! r �(/ ' � end maintenance ol Ihe improvement or other right�ol�way use hereto <br /> �- �"' ��'t�� � ��� �y�� epplied lar and luriher agrens lo remove same upon notice hom Ihe � <br /> �� Approved lor Corl iruction �a�e Clty and to replace pu6lf�pperty damsged thereby. � <br /> / � <br /> � �� -f'-5• ' ! � <br /> I� j <br />�' FI ION Dete - / — l�s��— <br />�'I �� Approved ae Conetructed �S� etme ol ApplicQ � Date <br /> eve�rtf PUBLIC WORKSDEPARTMENT WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN ,, <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere��,WABB201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE II <br /> �hone:259�BB10 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PFOJEC7 OVER 90�AVS DURATION. <br /> I <br /> t <br />