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. " ' <br /> �0t8 � �� JU � P�M,c Wo���nvmn� �,��o <br /> oma o.n� � <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT °°^r�,��::�°° : <br /> l�u�po� �sevam S <br /> eaiancn0u� S Zd <br /> Print or Type Only <br /> ��c U�l�ll,�i (-1/ � j'o 3o,C S��C� l.`1���..�,��oD I.1(-' �h"U`f� �1-�N3'� <br /> Ownar Mailing Adtlress C�ty Zip Phone <br /> Applicent Meiling Address City Zip Phonc <br /> Deecribe P�oposed Work <br /> W <br /> - �, �'-� � ` " H <br /> Prc�acl Address lif knownl <br /> Attech lour 14)��p�es ol plens lor proposed work• Drew to scale entl note ihe lollowing as applicahle: � <br /> • Proper�y Llnes • Centerline of sireot � <br /> • Outline and dimansions ol ell ezisling end • Indlcate North <br /> proposed slruclures on the lot • Show eny proposeA grading chany�s <br /> • Exlating and proposed utllities • Show meesu�ements M <br /> W <br /> DO NOT WR TE BELOW THIS LINE - O <br /> PERMIT CONDITIONS � <br />� 1.All cella fo�Inapecllon ahall be made 24 hrs.In edvance•phone 259•8810. � , <br /> 2.All work ehell ba pedormad In eccordance with this permit und current Ciry of Everett Design and Constructlon <br /> Stende�da end SDeclficatlons. <br /> 3.Call Locatlon Underground Service 48 hrs.belore you dig.TOLL FREE NUMBEF 1•800�424•5555. � <br /> O <br /> � <br /> 04/04/90 2��9F'M ODUAk0833 � <br /> N0003326Z O <br /> �,.� ,�o.� a <br /> cASH s�o.uo <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> , ,� The undersigned owner/eppGcan�herehy agrees to holtl and save hprm- <br /> , less Ihe Ciry of Everett irom nny end all cleims lor damaBes. costs. <br /> '� expenses. or causes of action !hat may arlse beceuse ol installation <br /> � xnA mainlenance o�fi9 imp�ovemenl or other �ighbol�wey use herelo <br /> eppli t r nd � Iher�p grees lo �emove same upo� nolice irom iha <br /> Ap roved lor Constr tlon � e Ctly nd t �pinc publ�t propert dameged Ihereby. <br /> � ��� �'�s ����� ��� �Q <br /> FINAL INSPECTION Date � Date <br /> Approved as Construcled Sig at��e ol Applicant <br /> WORK AUTIIORI2ED BY THIS PERMIT'�dUST BE STARTED WITHIN <br /> everetl PUBLICWORKSDF.PARTMENt 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DIIIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everetl,WA98201 CANCELLED BY TIIE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> P�one:259�8B1J PROJECT OVEii�JO DAVS DURATION. <br /> I <br />