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' b '•l d"'< Pum�cwo�xsPermu+ <br /> ��� <br /> Date i ' ,�_. <br /> - ema oeo���--"� <br /> � qpplication For � <br /> i <br /> ' PUBLIC ValQi�KS PERNiIT `°���"`"�„=FeV 5 <br /> ToiaiFee <br /> I <br /> "x C""7 I �ess aoo� Fee aam 5 <br /> hy�� , Daia�ce ouc 5 <br /> „��x ��� Print or Type Only <br /> q H <br /> �H[n <br /> H �i�-+ � : :1 . � f�� :i- �. ,_- . ' ti - : �i' i= itfi. �Jc j ..:, . <br /> K O Mailing Atldress Cny Zip Phone <br /> y� Owne� <br /> � A1H I P.t ��;; i ]at �Y / / � . .!�7- �/' ll 7 JS-5 /�L/ � �. <br /> y r � Mailing Address � , /Ci�y Lp Phone <br /> x z g , APplicanl . <br /> n o t� <br /> OH� � <br /> c7 Describe Proposed Wark "�'� � ��r�t� I <br /> � hg <br /> �,� � <br /> a ��� — ' e ' , <br /> r r�H . --- dii <br /> � V i — �-- � <br /> H I.. ;� :� �. �: <br /> C �,p i ProjectAtldress�ifknownl �--. <br /> , �� <br /> � ��. qttach four IQI r,oGies o�plans lor Propos�a woih- Draw to sr.alc antl notr_ Ihe lollo��ine�as apPl�cal�ie' � <br /> z �a� • Property Lines • Centedme o�sireei <br /> H O CA • Indi '+�e Norih <br /> , • Outlfna and dimen510n5 0�all exislin90nd O Sh� ��'/ Pi-:: "I�;r:"1�m. :�'�<i�'"- <br /> nroPosed struclures on u��.Ict • Sho.v nu�risiu��incnL; � <br /> ' • Exlsting antl proposed unld���s � <br /> j DO NOT VJRR[ �ELOl7 THIS L�NE � I' <br /> II pERMITCON0ITIONS �� I <br /> i 1.All calls!or inspection shall t�e made 24 hrs.in�dvance�phone 259•8810. <br /> „� 2.All work shnil be peAormed in accortlance wiN Ihis pe�mrt antl current Ciy�ol Everett Design and Censhuction <br /> �t�x � Standards and Specifications <br /> ���� ' 3.Call Loca�ion Under9wund Servir,e�£1 h's.bclore you di9.TOLL FREE NUMBER�-SOO-GZ4•BSSS. � <br /> �.,, �� � � <br /> ,� � <br /> I � � . � j <br /> i «' I � � , / , ♦ � <br /> _ �_•• j.i: <br /> i: "'j <br /> - � ' � <br /> _s p <br /> W <br /> � ! � <br /> I ACKNOV'JLEDGLAIENT OF CONDITIONS � <br /> � �' The midr.rslgnetl owner/apPl¢aN hereby a9reas Io hold and savr h:�nn- � <br /> -= ?! � less ihe Cdy ol [veiell irom any and all claims lor dama9es, cos's. <br /> �xpenses. or causes of aclion Iha� may arise because of ins�ailation <br /> � and main�enance of Ihc improvement or other ii9hPof�way use hereln , <br /> � _ appl�ed lor nnd iwlher a9ree5 to iemove same upon notice Iwm the � <br /> �. �np�oved for Construction Date Ctly and lo reP�ace Uubhc proper�y damaged ihereby. <br /> � PINAL INSPEGTION ���e - Dale � <br /> �' Apnrovetl as Cons:ructnd Si9naturc ol ApP!icant <br /> WORK AUTHGR12ED 8Y THIS PGRMIT MUST BE STARTED W�THIM � <br /> � . , . �LICWORKSDEPARTMENT 160 DAYS OF �ATE PERtd1T IS ISSUED �NO TH[REAFTER IS TO �� <br /> �viuu PU <br /> , � 3200CedarSlreet BE DILIGENTLY PURSUEG TO COtdPL[TION. THIS PERMIT MAY BE <br /> Everelt,WA98201 CANCELLED BY THE CITY UPON AWY STOPPAGE OF WORK ON' 115 <br /> Phone:259�eB10 PROJ[CT OV[Fi 90 DAYS DURATION. <br /> i . _ _'_ __ ._. __'--__'—_-- <br />