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pO�Q? s_yi . I �uplrc Wa��Parmll• <br /> Appllcellon Foi 9�av o.n�.• <br /> PUBLIC WORKS PERMIT PubGCWorM�F�� <br /> Tol�l Fea � <br /> Le�e ApO��Faa P��E � � <br /> B�lante Dw { <br /> Print or Type Only <br /> T/,e 8oP�29 Co. P.D. t?nr 37n7 Ms-OF�iG S�o�l`!e��vo, 9Bizy- 2zo7 3f�z-s�7B <br /> Owner Melling Adtlresa City Zip Phone <br /> �l.ln er <br /> Appllcant Melling Add�ess City Zip Phone <br /> DescribaProposedWork 17�a--3$� l�u���inq <br /> J <br /> W <br /> Pro�ect Address pl known) 00.� ina � <br /> Altach lour(4)coplea of plana lor proposed work- Drew to scale end�ote the lollowing es applicable: � <br /> � Property Lines •Centerline ol slreel � <br /> • Outllne and dimensiona ol all e�iatinp and � Indicale Norlh <br /> proposed atructures on the lot • Show eny proposed grading changes <br /> � Exiating and proposed utlllllea • Show measurementa � <br /> N W I L HI LI O <br /> PERMIT CONDITIONS <br /> 1.All cells fo�In6pedlon ehell be mede 24 hre.In advanca•phone Z548810. � <br /> 2.All work ehell be peAormed In eccordance with ihle permit and curtent City of Everett Deslgn end Conetructlon <br /> Standarda end Speclllcatlana <br /> 3.Call Locatlon Underqround Servlce 48 hra.bafore you dig TOLL FNEE NUMlER 1•800�424�6656. � <br /> �'c,��. �«e�✓'�r ,tilid e2<.��'.�.:�, C�,ea. �a«�v�C' O <br /> L'o�-yaQ�-tc./� e�,, �`�v 5��-zs .��lc� �1n22s����/1�vcQ.�.r H <br />. tJ/L�d ,,�U�.La W�Zf ,QE2/•�.� ��V� �Q�[G'L�• V� <br /> ��{ O <br /> �JOo/�"'✓ <br /> 3-9, a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and eave harm- <br /> less Ihe City of Ev3rett from any end ell claims lor dameBes, coats. <br /> expenses, or cause.ti ol ectlon that may arise because of installatlon <br /> and meintenance ol the Improvement or other riBhl•of•wey use herelo <br /> applied lor and lur!ner agrees to remove same upon nolice Irom the <br /> Approved lor Constructlon Date City and to replacn public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Conatructed Signelure ol Applicant Dale <br /> � PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY 'lHIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreel 1B0 DAYS OF DATE PEHMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretC WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:269•BB10 CANCELLEO OY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />