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oa'e>' � 6'G- GC7 <br /> Pubbc Woib Ve�rmyil•j � <br /> Applicatlon For Bi�p Oeo�-�..pL�L/���� <br /> PUBLIC WORKS PERMIT PVeToInlFeeFee a <br /> les��pD�.Poe f`ela S ' ��._,� <br /> Print or Type Only B�IenroDue S �-� <br /> �an S!'e /�uuy 3//6 //3�f'�.Sw E��2:� `��6 `/ 35-3--I�a3sC <br /> ��-�woe� Meilinq Addreas City Zlp Phone <br /> �'R �" � <br /> l � �/�uc� .��/G � f! SC_✓ l:,en-f� `/'u:�U`/ 35,� •- 03S' z <br /> Applicent —�— Meilina Address COy 2IP Phone � <br /> ° �) / C) <br /> Describe Propoeed Work /� i /c�� �[/�+_�'�_x — m <br /> ` .. <br /> -- .. .. <br /> - --� T� <br /> � -i <br /> _ � �m <br /> cc I <br /> ProJect Addresa pl known) ���-� .�S�%�' Ch'ESi�f/UT S'i __ H �^� <br /> o�3 <br /> Altech lour(4)Coplea ol plena I�r proposed work• Draw to ecale nnd nute tho�ollowing as applicable: � �n <br /> • Property Linee • Canterlina ol street � m.._.� <br /> • Outline and dlmenaione o�ell exlsling end • Indicata North � <br /> proposed structurea on Ihe lot • Show any proposed grading chenges Q = <br /> • Exlating end propos�tl utllitles • Show measuromants � <br /> � i <br /> DO N(�WRITE BELOW THIS LINE � � v+ <br /> O � <br /> PERMIT CONDITIONS q ;a <br /> 1. All calls lor Inspection ehell be mado 24 hr,; I�edvence�phone 259•88�5. <br /> 2. All work shell ba paAormed In eccordence with this pe�mil end curren�Ci�y ol Everett Design and Const�uction � _ <br /> Stenderdn end Specilicellons m�+ <br /> 3. Call Locatlon Underground Service 48 hrs.beiore you dig.TOLI FREE NUMBER 1•B00•424•5555. � <br /> or <br /> � l�i��c.cy.✓�"s��c� TNS�%AL! fI d9C.cru.qrE.� l.!qL�E � �N <br /> c7N TNE Si1�E SE�dE.C'. t�iE Tc, TNE Ob'e,c'Cc�qvEO <br /> S'E or/Eie /�7�9in/. ��o <br /> � iP•'lOF' I��.F'A�n.� Sii'ALL i3E rTbHT�iNEs� To T�'E � � <br /> SEH/E•e S1/.rTEM• � _ <br /> �.j ` i�� -ttiA ...r/� Cc%� �� / v% l�l A S Td h'E � � <br /> .�F�9 G�t/E� /T C'U•nE it/ .fT.r^./i� — OF'-�' �n <br /> C/� ST �T i. r a o <br /> �,[' T.s%c fi��Ic G- ��9T i,c'� � <br /> � %��E E itiN/i /L lJ l'E�G� ync s F To Oi�E�: S il�f O/��DT' n <br /> m <br /> ACHNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appllcant hereby aprees�o hold and save herm� <br /> less the Cily of Everett Irom any end all claims for damages, costs, <br /> -� expanses, ar causes al action ihet may erise because of Instelletion <br /> � � � end maintenance of the improvement or other nght�o4wey use horeto <br /> A ,6 ed lor nsVu n epplied lor an riher agrees lo remnva seme upon notice irom the <br /> � Date City and to plo e public properly damaged Ihereby. <br /> � � �- 30_� /. <br /> NAL INSPECTION Date �/�' � <br /> Approved ae ConsVucled Signat re of App � art <br /> Dnte <br /> evemtl I'UDLIC WORKS DEPARTMENT i WORK .4UTHORIZED BV tHIS FRMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Siree� 180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br /> Eve�eO,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 9F <br /> Phone:259�8815 CANCELLED 8V THE CITY I;PON ANY STOPPAGE 01�WORK ON THIS <br /> PROJECT OVER y0 DAVS DURATION. <br />