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� <br /> DB�Q j 7 p PUEI¢Wa.Me Permi!� �� �� <br /> AppliCatlon For aieo oec�.•— <br /> PUBLIC WORKS PERMIT PueTot�FeeFee , �.�,. �,� <br /> Lev�ppl Fee Pe�d S <br /> B�I�nceDue S ��' UCJ <br /> Print or Type Only � C ��rr <br /> / /� !�('�tT'�-4' N��/lt c.� <br /> Owner Melling Address Clty Zlp Phone � <br /> IVA�bA�rr LoNs I� �-I1� H(Ci(�i.-+1 .�i� r i�dtr�/�+ `� L��`'/ L� � -� YS�• <br /> AppliCant Malling Address Clty Zip Phona <br /> �� <br /> Desaibe Proposed Wo�k 6��(`n Y L G, 9/,% L�r./� f�i`�� Il ,QnTc 5% F��•� "f va. � <br /> �..c��pv C �/ � Y C�r->�n ..��- — �Pn�e p�, b� �.�' C�+�l'f �yf�.I <br /> . � <br /> W <br /> Prolect Addrese(11 known) Z ( �Y � r�(C-� r'�-t� � � <br /> Attach four(4)coplee ol plana for p�oposed work- Draw to ecale end note tha lollowinp es appliceble: � <br /> � Property Llnes • Centarline ol slreet � � <br /> • Oulllne and dlmensione ol ell exlsling and • Indicete North <br /> propoaed etructure9 on the lot • Show eny proposed prading chenges <br /> • ExiatinB and p�oposed utilitlea • Show meesurementa � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONOITIONS <br /> 1. All cells for Inspectlon ehell be mede 24 hrs. in advance• phona 259•881 5. � <br /> 2. All work ahell be perlormed In eccordence wllh this permlt end current City of Everatl Design end Conslruction <br /> Stande�ds and Speciflcatlons <br /> 3. Cell Locatlan Underground Service 4B his. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underslgned owner/epplicenl hereby egreas to hold and seva heim- <br /> leas tha City ol Eve�ett from any end ell clalms for dameges, costs, <br /> ��� expenses, or ceuaea of action thet mey erise beceuse ot Installelion <br /> �� 3. ].fy end malntenence ol the improvemenl or olher right�of�way use he�eto <br /> � epplied for end luriher aBrees lo iemove same upon notica Irom the <br /> pproved lor Construc�lon�� Dete City end lo replace public property damaged ihereby. <br /> -.�---_-- / . <br /> 1/�.:.��_>�./ s- �'- H y /'�j(�,�L` <br /> �FINAL INSP[CTION �B�e �� + " "` � 3 7 —�y <br /> Approved ee ConeVucted �eture of Applicant Dete <br /> everett PUBLIC WORKS DEPARiMENT WORK AUTHORIZED Bv THIS PERMIT MUST BE STARTED WITHIN <br /> 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedei Slrea� BE DILIGENTLV PURSUED 1'O COMPLETION. THIS PERMIT MAY BE <br /> Evorett,WA 98201 CANCELLED OV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 253�8815 PROJECT OVER 90 DAVS DURATION. <br /> F I <br /> I � <br /> 1 <br />