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<br /> + Date�P_� � �„���,�m.w,ro,m��.
<br /> ���'� Applir,a�ion Fcr � r.m� o�.pi , ____ '
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<br /> ��x;� ��� PUBLIC WORK!��PERMIT ra„�.e� 5
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<br />:, -- [ �+ Print or"i ype Only � c� o -- �
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<br />�e � . � H� Owner Mading Atltlmss o 1 City Lp j� Phone �
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<br /> � o� C'lEo�'iTr�'ir /'�.��-c��l-�',F' �/c��_�.��F.S���. C�c�i���i�s, �CI�, ��vz�> ��s-,��c,; �
<br />��'� y� Applicant — Meiling Address Ci�y �Zp Phone� �
<br /> ON�y � 7 �'� Y�� �7 , ' �1 1
<br />��'� ' . H C�]O Oescribe Pro osed ork /� ��-. C' �'l ��-G'�1..'�(.� �^(�/ rl. V w I �J.li�•� �-�i�-� �I
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<br /> � 5 r Proled Addres5l�� known�
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<br />� z y� Attach fom�4)copies o�plans lor proposed wo�k� Draw to swle antl note lhe Ioliowing as applicable: ��
<br /> �-3 O V1 • Property Lines • Centerline of sireet /� �
<br /> • OuUine nnd dimensions of all exis�ing antl . • Indicale Nor�h V� �
<br /> proposetl siructures on ihe lol • Show any proposetl gratling chanyes
<br /> • [xisimg and proposed utilities ! • Show measuremenis M
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<br /> � } �� DO NOT WRITE BELOW THIS LINE �
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<br />� yr��� PEFMIT CONDITIONS ,' Vs
<br /> q ''� y 7.All calls lor inspection shall�be r,iade 24 hrs.iii advance-phone 259•8810. sy
<br /> � _'' .e,�� 2,qll work shell be pedorrrfetl in accordance with ihis permit and current City of Everett Uesic�n and Construction ��
<br /> y , Stantlards and Specilications.
<br /> � 3.Call Location Underyround S�e 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. �
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<br />�t � :. ��.. � 5� C(/��Q�C '�/?2c.cti.�.da� CG4�c�L� —�a-iis�Cc-��i_i_L�:-' �YC�:��h2Lc;Y.i, �
<br /> �, �} �.. .J �l �z ,¢�v �G�YLf��'C.'!"(C/„'� �t?�''�/ iL/W C�LG'tj' ��C(.(�C[(�/ �
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<br /> Fz� T ����— .Lsw��i.tJ ��-'�- C!T?J-�'�2c�>z� Cu�c��:a.;� ���'.. �
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<br /> "� (�.�`7 ACKNOWLED6E1.1ENTOFCONDITIONF �
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<br /> " � The undersigned ownebapplicant hereby agrees�o hold and s�c h� m-
<br /> x less ihe City ol Everett irom any and all daims for clamac� � c.o-�:s.
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<br />� � .T � � � expenses, or causes of action Ihat may arise because ol insta:lil on
<br />�4 ` �_! ���5 /��Gv1�r/ ,�i/�/pb antl maintenance of ihe improvemenl or other riahbobway use nuelc
<br /> *� � L' '�l` / �� applicd for and lurther a9rees to remove same upon notice Irom �h��
<br /> '.� Approved lor Conslruclion� ��e C�ty and to replace public properly damcged thereby.
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<br /> �y FINAL INSPECTIUN Date - - � � -
<br />� �� Approved as Conetructed ignatur ol AppllcsM ����'
<br /> cverrll PUdLICWOPKSDEPARTMENT WORK UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN
<br />� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 10
<br />�.� � 3200CedarSircet BE D�LIGENTLY PURSUED TO COMPLETION. THIS P[fi�dlT P.1Av B[
<br />° . Everett.WA 9R201
<br />� � �� CANCELLED BY THE CITY UPON ANY STOPPAGG OFl70RK ON 1I�.i5
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<br /> Phona 259�Bd10 PROJLCT OVER 90 DAYS D'JRATION.
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