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�a�e� �u�l¢Wo�4a Permn� _ o�G�� <br /> Appllcutlon For eiao oev� • <br /> RUBLIC WORKS PERMIT PUEI1cWod�Fea <br /> Tolal Fea s <br /> �����00�Fee Pe1E � <br /> � Balnncr Due f ���O <br /> Print or Type Anly <br /> �55 e I No��S 1�'h � 130�� ��fl�/( i,,.l, �y �e��l� c-� ��?��$ 3 3 7-yat� <br /> Owne� Malllnp Addreas Clty � Zlp Phone <br /> _.�A MVI � A S A�nV'L <br /> Appllcant Mallinp Addresa City 21p Phone <br /> Deac�lbe Proposed Work ��✓15� rl.�L� �'1 C'�✓ S r ln� �-e �yu I+�i/4 l�'('S.ri'tYr(C— <br /> � <br /> Project Address(If known� Sp�Z '� �/�//�✓LZ9.0 ./7�P � <br /> Attach four(4)coples of plans fo�proposod work•Drew to acale end nole ihe lollowlnp as apDlicable: � <br /> • P�operty Linee • Cente�line of etreet � <br /> •Outline and dimenslons ul all erleting and • Indicete Nonh <br /> proDoeed atrucluree on the lot • Show any propoaed greding chanBea <br /> • E�letinp end p�opoaed utllitles • Show meeeurementa � <br /> DO NOT WHITE BELOW THIB LINE � <br /> PERMIT CONDITIONS <br /> 1. All cells for Inapecllon ehell bo made 24 hra In 4dvence•phone 289•881 S. � <br /> 2. All work ehall be partormed in eccordance with th�;,nermlt and current City ol Everetl Deslpn and Conetructlon <br /> 3tenderds and Specllicationa <br /> 3. Call Locatlan Undarp�ound Service 48 hrs. betore yau dig.TOLL FREE NUMi?R 1•800•424•5555. � <br /> . ` <br />�,. <br />� O <br /> � <br /> � <br /> O <br />�� a <br />�' � ACKNOWLEDOEMENTOFCONDITIONS <br /> The undareiqnod owne�/epplicent hereby agreea lo hold and eave harm• <br /> leas the City ol Everetl from any end all clelms lor damepes, cosle, <br /> expenaee, or ceuaee of aclion fhet may arlae beceuse of Installatlon <br /> �� 6_ _ end melntenence ol Ihe Improvement or other rlghl•ol•wey uee he�eto <br /> applied tor end further ag�ees to remove aeme upon notice from ihe <br /> Approved lor Con r on Dele City and to replece public properly demaped t by. <br /> % -'-��'��- ._ / <br /> FINAL INSPECTION Date �11 � <br /> Approved�s Conatrucled Signet e ol Applicenl De e <br /> everctt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 1J0 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILI6ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:2E9•BB1 G CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON Tfil9 <br /> PROJECT OVER 9p DA'/S DURATION. <br /> I <br />