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�BtB `� '�'91 Pum¢wo.h�Pmmu. JI �` _ <br /> `� Appllce�ion Fo� BiEp Deo� • <br /> u� <br /> PUBLIC WORKS PERMIT P�biolefee�e� s <br /> O <br /> q Leu�pDl Fee PuE S <br /> 6 <br /> � fj BelenceUue S ZOJ <br /> Print or Type Onl� o � i <br /> u' � ;;;� i <br /> �� !�I�fI�OT�' � Jd'iV S�7/1/ ,�e ti ,' �z �. �,�: ''� 2= �i- ��O!<a y <br /> Owner � d °i1 �� MeJing Address Ciry LP Phona � �,� <br /> . r� �- a <br /> • / � o��i ��a °i L� � � , . , � ` . ..�V <br /> . Applicant Mailing Address Cily Zlp Phona ,, <br /> � 12C7\V <br /> rGn ct ; „ '4 <br /> �. DeSCribe Proposed Work � <br /> ' W <br /> r 1 G Fi'�ST�.1 U � <br /> i Prolect Addresa Iil known) <br /> 1 Attach low(4)coples of plens lor proposed work• Orew to scale and note the fo�lowing as applicable: � <br /> � Proparty Llnes • Canlerllne ol street � <br /> • Outline and dimensione oi all exiatlnB and • Indicale North , <br /> � propoaed atructures on the lot • Show any proposed grading changes I � <br /> � • Exlsting end proposed utilities • Show measurements �A <br /> , W <br /> ; DO NOT WAITE BELOW THIS IINE O I <br /> t � <br /> �� PERMITCONDITIONS <br /> 1'- 1.All celle lor Inapedlon ahall be meda 24 hra.In edvence•phone 259•8810. � I <br /> i�, 2.A l l w o r k a h a l l b e p a d a r m e d I n a c cordence wlth this pe�mlt and current City of Everett Oeslgn and Constructlon <br /> f� Standerds end Speclllcetlons. i � <br /> i; 3.Call Locetlon Underground Servico 48 hre.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � �. : <br /> � �}� � v� S l-.�L I G O r v�e-✓ c..�t. csFl�-S o-o .��.� h �¢.a �n ¢71 rrn. O , <br /> ¢ I <br /> > <br /> !. � I <br /> �' � ' <br /> S�' O <br /> � a� <br /> � <br /> �� <br /> ���ry, ACKNOWIEDGEMENT OF CONDITIONS <br /> �•,. The undersignod owner/npplicent hure6y agrees to hold and save haim� � <br /> less Ihe City of Everett Irom any and ell cleims for dameges, costs, <br /> expenses, or rauses ol eGion ihat may arise becausa of insinllalion <br /> ���C.Lf... �j - I L} -y 1 end maintenence of ihe Improvement or other right�obway use hereto <br /> �� �-�%L applied for and furiho� ngrees to remove se upon nolice Irom the <br /> S;+' Approved fo�C tructlon Dete an o repl e pu6lic properry dem d reby. <br /> �� �3l' � �G - �f- �i/ Q. <br /> FINAL INSPECTION Date <br /> .�. Approved ae Conalructed ignatu e ol plicent Date <br /> WORK AUTHORI2ED BY T PERMIT MUST BE STARTED WITfiIIJ <br /> ;J,�' PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PER T IS ISSUED AND THEREAFTEF IS TO <br /> 3POOCedarStreflt BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> �,i�� Evaret�WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WOiiK ON THIS <br /> P�one:259�8810 PROJEL'7 OVEF 90 DAYS DURATION. <br />� <br />�— � <br />