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, _.__.._------. <br /> �B�eJ�.�JL.� PUELc Worb Pn`rm.,lt,•�-—",.���—���/j—/— <br /> AppllCetlOn For Biep OeD� � x � � Jla�L�—_ <br /> PUBLIC WORKS PERMIT P��IICWmktFe� � --- <br /> ,o,.,... <br /> leu�pD�fea PUE �_� <br /> B�bnce Due S�� <br /> Print or Type Only <br /> \�L�� n C v. ��Gw�nL� d ��� Wp.. n. A�� Sihr��lUoefl Qg�12. �a- k�9y3 <br /> Owner eIIInB Addresa ity 2ip Phone <br /> rn� <br /> Appllcant Meiling Atltlress Clry Zip Phoae <br /> Deactlbe Propoeed Work Alo .� nS�� �1 l7\�. _ <br /> /1 W <br /> Pro)ect Addresa(If known) �S�J�1,���. D CyES�if/Ur !�l�f� <br /> Atfech lour�4)coples ol plane lor propoaed work•Drew to scele end note the lollowing as epplicahle: � <br /> • Property Llnes � Cente�lina ol sireet � <br /> • Outline and dimenalons ol all existing antl � Indicele North <br /> proPosed etr•�cturea on Iho lot • Show eny propoaed predinp chen4es <br /> • C:xiallnp anf proposed utllNles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> . 1. All calls lor I�apectlon ahall be meda 24 hra In advance-phone 259•8815. � <br /> 2. All work shell be pertormed In eccordence with this permit end current City ol Everett Design and Construclion <br /> Stenderda end Speciffcetlone. <br /> 3. Cell Localion Underground Service 48 hra.beloie you dip.TOLL fREE NUMBER 1-800•424•5555. � <br /> � lvo.P.� r� BE- z�.c�' �•� A�r�t'ciYco O <br /> /9f�ivPOtit� S/Tl �.lstc./ 1�TF0 ///B: <br /> S ry.�PG�c�9a/T' �fCJST f�Lf7' fi� /�'2 Xn��rJ'rt/GE H <br /> / � <br /> 6'o�faAR/� fti T.s� S,oEw9Gk: 7NST.9Gli9Tio.� O <br /> L�Ef��� /��',en,i7-f i9•BF /J'.f'dE�. � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigneJ owner/epplicant hareby eg�eea b hold and seve harm� <br /> — less Ihe City ol Everett irom enq and all claims lor damages, costs. <br /> Iexpenses, or causes of ectien that mey arlse barause ol Inste�letion <br /> ��� / ���� / ��L and maintenance ol !he impiovemenl or other righboFway use herato <br /> � �� applied loi end luriher egreos to remove same upon no�ice Irom Ihe <br />� Approved lor C slructio� Date C' and to ieplace p lic property damaged iherehy. <br /> ,T -/s-Fj // !� <br /> p,lllYf� IN "CT N Dale � ��� �J 5/�`� <br /> Approved as Const�uCted Signeture of A icanl Dale <br /> everett F'UBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUEO TO COMPLETION. TIiIS PERMIT MAV BE <br /> Everett.WA 98201 CAtICELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�BB1 5 PROJECT OVER 80 OAYS DURATION. <br />