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i <br /> r- "� <br /> Pu�lm Worb Parm�l• " /9� <br /> r�p �/ ) <br /> �O�B � � Y BIEp Dap1 � _[y_•y/��/�/ <br /> Applleeticn For <br /> PUBLIC WORI(S PERMIT P�oi�cWon�Fa� <br /> Tm.iv.. s o?�' <br /> i— <br /> L�u 110p1 f�a P�iO �� <br /> Bi1�nC�Du1 s �� <br /> Print or Type Only � -#�77�-�� <br /> --��-`i'�'J_J 5 71.3`/ C�A�eEm o Jf" C"�PQe77`' .3�.?' ,36 d3 <br /> Ownar Mellinp Addreas Ctly Zip Phone <br /> �nplicent Mailinp Addrees Cdy Zip Phone <br /> � <<n�cl" C'�(.[�_Ll—L/[Aiw <br /> Deecribe Proposed Work _ <br /> 4� � �r. <br /> Pro�ect Addreee III known) ��`3� `"'"""`r—'�`-� � . <br /> � <br /> Aflach four�4)coplen ol plene lor propoaed work� Drew lo scele a�d note the lollowmg as aDPlica�le�. � <br /> • PrcOerty Llnes • Centerline ol street � <br /> • Outllne end dimansionn of ell eKialinp and • Indicele North <br /> propoeed 6tructuree on the l01 � Show eny propoaed Bradinp chenBes <br /> • Erietlnp and propoeed ulllillet • Show measurements M <br /> W <br /> DO NOT WRITE BELOW TIiIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calle lor Inepaelion ehell be mede 24 hrs. In advance- phone 259•881 5. � <br /> 2, All work ehall be peAormed In eccordence with Ihie permit and cunent City of Everett Design end Constructlan <br /> Standards end Specl�lcetlone. � <br /> 3. Call localion Undarpround Service 4B hre.belora you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � .��,�s���,�� � s,� �,�y�-.T � �� O <br /> ' y,� �,s=�- I-- <br /> N <br /> � <br /> a <br /> ACKNOWLE�GEMENT OF CONOITIONS <br /> The undersigned owner/epplicenl heraby epreee to hold end eave herm• <br /> less the City ol Everett Irom eny and ell clalme lor demape& cosls, <br /> /�� � e�pensos, or cnusea ol ecllon thet mey e�ise becauso ol Inetellellon <br /> �-�� 6�S� and melntenence of the impmvemenl or other right-ol�wey use hereto <br /> applied lor end lurther egrees to remove eeme upon notica Irom t�e <br /> Appro �'lor Conatruction �� Data Cily end to replece public property damaqed thereby. <br /> � -�/'� `��` - �a S'-� , \ Rr— .�' Bo.9.A� J <br /> FIN INSPECTION Dete ���nyl� Dete <br /> Approvad ae Conalrucled Signalure of AVP�icanl <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STAHTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PEHMIT IS ISSUED AND TNEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLV PURSUED TO COMPLETION. 1N15 PERMIT MAV BE <br /> Everatt,WA 98201 CANCELLED BV THE CIiV UPON ANV STOPPAGE OF WOPK ON THIS <br /> Phone: 259�8815 pROJECf OVCR 60 DAVS DURATION. <br /> t <br />