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�... .. <br /> �BtQ�� Po�Ik WarF�Pverm�ll• 85-2/3 <br /> Appllcation For BIJp Depl �.[ .� �.� �� <br /> PUBLIC WORKS PERflAIT �,°„°W°,�.F°.— -- <br /> Tot�i�ee S— <br /> Lsu�ppl Fae Paia S <br /> Print or Type Only e.�.��.o�. t��-3� <br /> ��Nr��s �, � ,� qo3� 3s'�S ��5�. -r��.� �9 Z� � 337—�0�� <br /> Owner Meiling Addreas City 2ip Phone <br /> Appllcant Malling Address City Zip Phone <br /> Descrl�ePropoaedWork ry�w � —��x ` ��$�-kCT10� <br /> ProlectAddreas�if known) � �+�STNl1 � — L07,�?2 � <br /> � <br /> Attech lour(4)coples ol plena for p�oponed work- Draw to scale end note the lo�lowing as appilcable: � <br /> � Properly Llnea � Cenlerline of street � <br /> • Outline end dlmenslons ol ell existing and � Indicete North <br /> propoeed atructurea on tha lot • Show eny proposed grading changea <br /> • Exiating and proposed�tllitles • Show meesuremants � <br /> 00 NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1. All calle lor Inapection ehell be meda 24 hrs.in advence-phone 2G9•887 5. � <br /> 2. All work ehall be peAo�mad In acco�dxnce wilh thle permit end cu�renl City ol Everetl DesiBn and Conatruction <br /> Standerda end Specilicatlona <br /> 3. Cell Lxation Underground Servlca 4B hra belore you dlg.TOLL FREE NUMBER 1•800•424•5555. � <br /> f� Ta BE co,dsr.ea�r�0 PE.e AO.o2ovEo �GOR/S O <br /> A��'o 7-�a -�9s <br /> ✓� A�I�GdNT TO P�'avi�E PER�o,eirsaNGf' �iUd.P�NTEE' � <br /> �F� <LSioElE71�� /�t/ TisiE A/►�ou�✓T of'iSSoO =� `.p,e � <br /> ST.eEET T�nv�eorE�Ey✓•�' �' AccF'� Ps,v�.v�s e O <br /> a <br /> �JP"'� 1 �"� <br /> �v�^{ �./�RF t yv ACKNOWLEDGEMENTOFCONDITIONS <br /> l, ,9F The undersignetl owner/epplicanl hereby agrees to hold end aeve harm- <br /> lass the City f Everutt Irom eny end all clalme lo� damegea, costs, <br /> expenses, or euses o ction thet mey erlse beceuse ol Instellation <br /> .�� g . and melnten nce ol t Improvement or othar right-ol•wey use hereto <br /> epplied lor nd lurth agrae to rem�ve aeme upon notice Irom the <br /> Appro e lor n9trut�lon Dete City end t place p Ic pr erty damaged �hereby. <br /> FINAI INSPECTION Date �� � V� <br /> Approved es Constructed SI na le ol Ap icent Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHO ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar St�eet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet6 WA 98201 BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �hone:259•8815 I CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br />