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- -- ...�. , _ <br /> i <br /> Date �//-`�/ r/2 OyJ <br /> vumm wor�e Parmn. <br /> Applicallon For mau oeoi�. <br /> PUBLIC WORKS PERMIT ruetainFeeFee s <br /> Lea��oP�Fee Pe�ia S <br /> Pflflt Of lyp@ O�lly B�lenca Due S <br /> /�_F,i'/�l�T FF� <br /> �i�' f�'lic:r,� Gv, I�o. dnx ��'c'�J - /YJ � pf�_ � r <br /> C/�:)f l_FiJ c�•/ <br /> oW�e� � 7C S�> ffle t<ir JH/1 9� m� <br /> Meilmg Address ' City Zip � Phone , <br /> a'Y2 - S�p�B <br /> SAmi- E.�/ -► 2G6 3si3 <br /> Applitent Mai6ng Add�ess Cily Lp Phone <br /> DescribeProposedwork �7SfalL f�n�. , C��. �i. fiF� � �' - <br /> l�r.-.E�:,� L�.t �J �s',_ >� ,f • i•��aJ r.rft �.- Ya S! . <br /> J <br /> Bi r/��//1 <br /> Pro�ec�Atldress�ifknown) '�n�'� G[/, (�A����O iP0 � <br /> Altach lour(4)copies of piens lor proposed work• Draw fo scale and note the lollowing as applicable: � <br /> • Properly linea • Centerline ol slreet � <br /> • Outline and dlmenslons ol all existing and • Indicate North <br /> propo8ed etruc�ures on the lot • Show any pioposed gradinp changes <br /> • Exlsting and proposed ulililies • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calla lor inspectlon ahall be mede 24 hrs.In advance-phone 258•8810. � <br /> 2.All work shall be perlormed in accordance wilh this permit end current City of Everett Design and Constructlon <br /> Stendards end Specificatlons. <br /> 3.Cell Location Underpround Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> 7; �[/D�.� fv �ic" �!�n��t�., �t`l/7rGr. �c/ �i�i�.1 O <br /> ql�7fC0� 2'/�-�Z. <br /> �l ��� ��, � r �, - --� V� <br /> LJ �� � �� � <br /> FE6 191992 Q <br /> .......... . . ............ a <br /> CITY OF EVERl:7i <br /> Buildin� Divi�ion <br /> ACKNOWLEDGEMENT OF C�JNDITIONS <br /> The undeisipned owner/applicant heraby ag�ees to hold and save harin- <br /> less ihe City ol [veretl �rom any and all cteims for dameges, cosls, <br /> �� � . oxpenses, or causes of action thal may arise because of installation <br /> ��`y'_ � �� �,�7 end maintenance of ihe improvement m other righl�o4way use hereto <br /> Approved� Construction applied lor and lurlhn� agrees �o remove same upon nolice Irom Ihe <br /> �� �/ �81e Ciry and to replace public property damaged thernby. <br /> 3�'i c -� �y- � ,/ <br /> FlNAL IN5PECTION � �^�—Dat ' � � I • l���'�"� ��J��=� <br /> Approved as Consiructed Si9nature o Applicant Dale <br /> � PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEO WITHIN <br /> 3200CederSireet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eveiult,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:?59�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TFiIS <br /> PROJECT OVER 90 DAYS DURATION. <br />