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iJate �q �S &(o <br />: nplication For <br />PUBLi�C VIt�DFiKS P�R�UlIT <br />Prinl or Type Gnly <br />Pu�Lc Wai1s Permd e �(O �.�5� <br />eme� ocoi� + _ <br />Publ4 Wo�hp fee <br />Tolal Fpe g <br />Les9l�0� FpePaltl g <br />Balanre �vc 5 �Q�� <br />%7�^� �00 <br />�%7���; �F��'�� <br />JFM Constxvction 1231 Sout:h Directo.- Seattle, WA 98108 763-0320 <br />Owner MaifinnAddress Gity Zip phc��,e <br />S�7II'/.,' <br />qpplicant A,aili�3i.ddress Ciry Zip Phune <br />Describe P��poseC WGrk _ �OOStY'_.:: FOUL-P��:X <br />r—..--- ,�aG/ A G'� - i�"X...JGio� _ <br />F`�olect Add�ess (if known� <br />Atiach lour (4) r.00ies ot plans for proposed work - D:aw to scale and note ihe tollowi�g as applicable: <br />• Properry Lir,rs <br />P Cuthne ami dln�ensir.ns of all existi�ig and <br />prupased stwc!ures on t 7e lot <br />• 6.ie(�ng anJ proposo; u4'itics <br />PEAM� f CONOITIONS <br />• CeNe�line ol st�eet <br />• Indicatr- North <br />• Show ^.,ry proposed grading ch�ng�s <br />• Shew m;;asurem?nts <br />t. nu cal„ =nr mspeo;�o�..:` II b� made 24 hrs. in ad��ance - phcne 259-881 5. <br />2. All worl:.-t+all b� ps�ro�,. .eo ��i acr.��rdance with Ihis permit and aurrem �Ciry of Everett Design �nd Constrnction <br />Stanasrd5 an: 5 •e^i'A;r.,o.,s. <br />? Call L..cauon li��j.�r,�ound �erv,:e 48 nre. belore you dig. TOLL FREE NUMBER 1-f306•4245555. <br />y �^��lJS7N�t�G?� !�=c,�= .S'.�,�'.C'oor.c� �'�<'c`'iC�,% liAlE�c7 <br />, � <br />ii -�•� <br />—_, � _ <br />� ; ���t��� :y, �y . �� � <br />Approeea for�t�ctiun � �t �:ie � <br />'� ! <br />-f--- //�i'�r�,� 3�-�.� i <br />F1NkCEN:�PECL��;d —! .ate <br />Approaed aa f,onso � :�e. <br />evere[t �'U%]LIG �YORKS DEPAR�MENT <br />p C_00 Ce dar S�reet <br />��Ir Everett, t iA 98201 � <br />i� <br />�� Phone:e59�8815 � <br />ACr..JOWI_f-CGEI.1EiVT OF CONDITIONS <br />� <br />� <br />7he un �siynao ae�u�er/applicaN heraby ac�•ees to hold:�nd sa ie harm� <br />i�.:s R,� ;,il}; of Ev=r��tl Irom an; and all c!aims tor drimaces, cosis, <br />ezF'ansCs, or causes ci actior !hat may arise hPcause of installation <br />and -,n;enxnse uf the imprrrvement o� other right-of�way we hereto <br />a IieiNnr ;n�I�R;er agraes to rem�,ve same upun notice trom Ihe <br />tY an�� ?Rpl r uabL.• propertY da:�a9ed ehereby. <br />Z�. � <br />a� .., <br />�-) -� <br />Date <br />'i.(' � "�THORI.ZE[Tl'r� THIS FERMIT MUST BIE STARTED WITHIN <br />1L ..rS OF D4'.� ?Fiah11T IS ISSUED AND 1HEREAFTER IS TO <br />9E DILIGE��1'LY ^l..�i^U!'� T.J :OMPLEI'ION. THIS PERMIT MAV �E <br />CANCELLED 6V (HE Ci'Y UFON ANY STQPPAG[ OF WOHK ON THIS <br />PROiti.T OVER'10 DA': i DURATION. <br />