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y r <br /> J <br /> � __ � <br /> pr. '--_""_—' —_" __ —_"_ —_ _' <br /> C M . _ __ <br /> � HGo <br /> iil� ••_ <br /> y �, oate � >G 9/ , <br /> wo�+won�nmm� <br /> �C � a�ea n.e� . 1 a �°i� . _ :�yz t— <br /> Application For <br /> � �� PUBLIC WORKS PERMIT °�°o,;.;;°•• s <br /> �x �....�o�.,,�.,, s_ <br /> Pnnt Or TypB Only e.�.�:.o,�. S <br /> OM � <br /> � �g <br /> c�� � � /� <br /> ��r i�C.�c�,t—s—C�—_ _Ioo3 L,/ C�-E.�.--�c. /�'L' �;�,.�C��. 5 P ' v s Ya -a 7a P <br /> .�.�y Ownar Meilinq AEOrese Cily Zip Phonw <br /> N ' <br /> g�, , <br /> H <br /> ��y ppplicant Madinp Atldress Cily Zip Pho�f <br /> �� DaeCrlba PrOpoaetl Wurk �f�-A-�-O�---� <br /> ----� ��.�__ _ W <br /> Proiect Aderess�il knownl 1��� s'r z3 �3 si= sP� f 1 J w S'T 1/9 � <br /> Atlach lout(4�copiee ol plane lor propoaed work-Drew to scale en0 nole I�e lu s appliCable. ^� <br /> • Property Llne! • CantOrline of streel /� <br /> • Oulline anA dimeneione o�elt exiatinp entl • InEicete North V� <br /> propneed etructurea on I�e lot • Show eny propoeed qraAing c�enpas <br /> • Exietin9 and proF��seu utllitiea • Show meaeurementa � <br /> DO "L7i WRITE BELOW 7HIS LINE O <br /> PERMIT CONDITIONS <br /> '�, i All celle for inspectlon s�all bt mede 24 hra.in etivence�onone 259•881 Q � <br /> � ' 2.All work ehall be peAormad in acco�denca wilh Ihie permit anA current City of Everett Deeign and Constructlon <br /> Slandertla and Spqclllceliana <br /> � 3.Call Locetlon UnAerprounE Servica 48 hra belore you Alq.TOLL.�REE NUMBER 1•800�4245555. � <br /> �� f [ lJ[�� �, r t/. � . f . �� � � � <br /> I 1 ��� � � <br /> ' r+ <br /> �� � ' � <br /> � O <br /> � <br /> - a <br /> � <br /> ' ACKNOWIEDG[MENT Of CONOITIONS <br /> 1 The un0ersigneE owna�/epplicanl he�eby ep�eas to holC antl sava herm� <br /> � iess Ihe City ol Evarett Iram any anG all claims lor Oamegae, cnels <br /> ' atpen:es. or Cnu6ee al aclion me� may anse because nl instellation <br /> � antl mamtonance uf the �mprovement or olher n9�1-o4wey usa �ereto <br /> ; aOPi�etl �or antl �uh�ar agrees to remove same upon nolica Imm Ihe <br /> Approvetl lor Consiructlon Date ��, Cily antl to rep�ece oublic oroporty�emngeel Ihereoy. <br /> �INAL iNSPECTION Date . <br /> .�pDrmetl ae Conavuctea �� 9ignamre oi a0o��cani Uate <br /> PUBLIC WURKS DEPARTMENT WORK dUTHORIZED 9V THIS PERMIT MUST BE STAFTED WITMIN <br /> J200CetlerSireet �80 �AVS OF OATE PERMIT iS tSSUE� AND TNEREAFTEP i5 70 <br /> Everotl WA98201 BE DILIGENTLY PUPSUED 70 COMPLETION. THIS PERMIT MAV BE ' <br /> Phone:259�9810 CANCELLED BV 7HE UTV UPON ANV STOPPAGE OF WORK JN 'MIS <br /> PROJECT OVER 90 DAVS OURATION � <br />