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,.4, —� <br /> / 9 ' <br /> C'� D8t@� PuNic WnrMe Permit♦ / �i� <br /> n, � <br /> ��, BIEp Deo��• <br /> � � Application Fo� <br /> . PUBLIC WORKS PERMIT P����cWarbFae — <br /> Tal�l Fee S <br /> y� Le���ppl Fea o�iC � <br /> B�I�nce Due a �' �//��'6'G <br /> �` Print or pe Only � � • / / /� ��/� i <br /> ;� / (/[irr.i) C�5' JJ�/K• �'f'V[07� ! <br /> / <br /> -/D�D <br /> w�.. O er -nB Adtlress ity 71p Phone I� <br /> ` � .��'S=�odv ' <br /> D/�- <br /> pplicant Mailing Addrass City Zip Phona <br /> Deacrlbe Propoaed Work �{='�� ' .� i ,� � , <br /> r <br /> ' W <br /> _ , <br /> Prolect Addreee knownl � H <br /> Attech Iour�4)copiae ol plane for proposed work� Drew to scale nnd note Ihe lollowing es applicab�e: ���I r'pw14N I �) , � <br /> • Property Lines • Centerline ol sVeel �� d�"a � ' <br /> • Outline and dimensiona ol ell exlsting end • Indicete North <br /> proposed strucluies on the lot • Show eny proposed greding chpngea <br /> • Exleting end proposed utilillea • Show meesuiemenla � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All celle lor Inepection ehall be mede 24 hre.in advance•phone 259•8810. � <br /> � 2.All work ehell be peAo�med In eccordence with Ihle permit and current Clry of Everett DesiBn and Conatruction <br /> Standerde end Specllicetlone. <br /> 3.Call Locelion Underground Service 48 hre.belore you dlg.TOLL FREE NUMBER 1•800�424•5555. � . <br /> .Sf� ��i<< AZJ� 1�*y�.J (�j�ai.c. CYAA"�1— O <br /> �!!Y'!lte�f c'l'+ Z�^— . � '� J .� <br /> I <br /> l <br /> � <br /> � � <br /> O I <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignad owner/applicant hereby egrees to huld nnd save herm- <br /> less tho Cily ol Everelt Irom any end ell claims for dameBes, costs. ! <br /> ezpenses, or ceusea ol acllon thnl may erisa because of Installation i <br /> �G����y �/��,/ end mainte ce of �he Improvnment or o�her righbof-way use hereto � - <br /> . epplied 1or furiher agrees to r move seme on notice I�om �he <br /> Approvad for Conalru�jion Dete City entl lo e lece public prope�t megod ih re y. . <br /> y <br /> ��G'-l� �� �-�o� si � � <br /> FINAI INSPECTION Date <br /> Approved ae Constructed � eture oi Applicenl Date• t„ <br /> WORK AUTHORIZED BV THIS PERMI� MUST BE STARTED WIffII�J <br /> � PUBLICWORKSDEPARTMENi 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Ceder Slreel BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAV BE <br /> Eve�el4 WA9B201 CANCELLED BV THE CITY UPON ANV STOPPAG[OF WORK ON THIS <br /> Phone:259�BB10 , PROJECT OVER 90 DAVS DURATION. <br /> I <br />