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DB�B�%����7 Pum¢WorM�Permn r �/7 J�J <br /> Appllcntion For eiea�000� � ���� /9�C� _ <br /> PUBLIC WORKS PEF�MIT Pu�iicWork�Fee — - - ,f� <br /> Talel Poe � ___. <br /> Leu AoO�Fee PeiC S <br /> Print or Type Only e.�,���o�, a 3/��o <br /> �/LL �a�4'.f'i�i✓ .5-c�.i�-.�.�'=�9d' � E./E".f' i� 9$ O� �5.3- Y2Sf� <br /> Owne� Melling Address City 'Lip Phone <br /> ��ii,�� <br /> Appllcent Malling Address City =ip Phone <br /> Describe P�oposed Work _ b�'9S.F�lNT � yn�sE /�+c7L'F. <br /> � <br /> - s��1� � <br /> Prolect Addresa(if known� •�'�- '- U�EAti� .AI�Cr _ � <br /> Aftech lour(4�coples ol plene lor propnsed work• Draw to scele and r.nte Ihe lollowing as appliceble: �� <br /> • Property Llnea �• Centerllne of atreet � ' <br /> � Oulline end dlmenalons ol all existing and � Indlcate North <br /> proposed slructures on tha lo� � Show any proposed prading chengee <br /> • Exlstinp enJ proposed utllitiee • Sl��w measu�emants � <br /> DO NO7 WHITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 7. All culle lor Inapection shall be rnade 24 hra. In edvance- phona 259•881 5. � <br /> 2. All work ahell be performed in accordance with Ihis permit and currant Clly of Everetl Dasign end Constructlon <br /> Slendarda and Specillcetiona <br /> 3. Cell Location Underground Service 4B hra. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> SE�c��.�z in.o�.cl T� d� cc.tiis:.F�vc:6o �,E�2 <br /> f�i�•c'o✓l�o s'�A.v v.9r�n 9 �� -9� O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT UF CONDITIONS <br /> The undersigned owne�/applicent hereby ayroes to hold and save herm- <br /> less Ihe City ol Everett iwm any end ell clalms for domeges, cosls, <br /> X - erpenses, or causes ol actlon that mey eriso becausa of installation <br /> � and melnlenance of the improvement or olher right�o�•way use he�eto <br /> epplied for and further agrees to remove same upon notice Irom the <br /> Approved � Cansi[� c� / Dal City and to_replx-;e public property demeged ihereby. <br /> / <br /> �� -�3-2 -�P - ���y <br /> L SPECTIUN pa�e {'�1 ! . ��� 7u-�^ � ;/� <br /> � Approved as ConslructEJ SI nnt re ol A plicent Dete <br /> � everett PUBLIC WORKS OEPARTMENT WOR AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ' � 3200 Cedar SVeet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEFi IS TO <br /> Evaretl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY BE <br /> Phona: 259�8815 CANCELLED BV THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�30 DAYS DUFATI�N. <br />