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DB�e S Z �B Pu�lm Woihe Pn�mu� f/_�7_�'_/�/ <br /> Applicetion For eiao oea�.. — ___. __. . .. <br /> PUBLIC WORKS PERMIT PU�ToleFeeFeo s — <br /> Less.�pPl Fee Paid s <br /> esiance Oue s 1� <br /> Print or Type Only <br /> D(/��E N�. ARQouaiti� /�o b /�!<ivi/7 <iv'- �ii._�E'riT y.f3v/ .�.,S.Z -�.S/b <br /> Ow�er MeiFng Address Ciry Zip � Phone <br /> Q//AN.� iJf. deiJn .JNii1/ /1nL� /.Ji=uiii� !�!/rr r-I/�.F-.r'iT ��1c�/ uZJ.1 '.�-S%Lr� <br /> Applieant Mailing Address City 7_ip Phone <br /> Describe Proposed Work ^ - �N ^' r � ! • <br /> 0'_�i�ST � '���� C i�✓L-' <br /> �` �J W <br /> Pn�Ject Addroas(�f known� /�1 � ��uJ r 1T /-jLi! F'UE.f���7r YB,�YJ� � <br /> Attech four(4)coD�ee of plena for proposed work•Draw to scale and note the Iollowing as applicable: � <br /> • Property Linea • Centerline of strc�et � <br /> • Outline end dimensions of all existing and • Indicate North <br /> proposed etructures on the lot • Show any proposed grading chenges <br /> • Exlstinp antl proposed utilities • Show measurements � <br /> 00 NOT WRITE BELOW THIS LINE O� <br /> PERMIT CONDITION3 <br /> 7.All c�Ns for Inepedion ehsll be mede 24 hra in advence•phone 259-8810. � <br /> 2.All worlc ahNl be psAamed in accordance with thls permit end current Ciry ol Everetl Design and Conatructlon <br /> Shnduds and 3pecMkations <br /> 3.GII Loc�tbn Undsrqround Service 48 hrs.before you dlg.TOLI fREE NUMBER 1•800�4245555. � <br /> P. �.� A.9�ic�TJ' �N(i�NBfK. is .e�Qw.e�o To �nare� O <br /> �, I�isuNt I�vs.o�cr�o.v a� r.v� lw.Ma eY�,e�a,t� COn/J'!'Q�IGTo.fI <br /> �/p P.Qov�06 T�rfE C/73/ GtliTi! Le/.p�nE•�/ 11/CiiF�C�9Tio�(/ � <br /> T.✓.9r �Pacr�,ey f/�s B�•✓ eaurr•ev�r�-o �°.�� T� � <br /> ����� //� /�9S P.¢ovi0E0, � <br /> OS/09/88 12:15M1 OOOAN0496 <br /> .S A��t�c.v.✓> w�c� iuor..�y T.✓F �r�,o ae-Fc�esf�..v� <br /> /�N� .E.YfiYv./Tion/ ARo!/�//,� 77/E POctIE'•e Jb� DPT.20 f20.00 � <br /> ,Q� G'o.e.�.�•c a� T.yE ��,ri.✓G [oT, CRSH t20.0U <br /> ACKNOWLEDGEMENT:�F CONDITIONS <br /> The undersignetl owner/applicant hereby anraea to hold and save harm• <br /> tess the Ciry of Everett irom any and all claims for damages, u�ats, <br /> �/ expenses, or causes of action that may arise because of inslelletion <br /> and maintenance ot Ihe improvement or other right•ol•way use hereto <br /> applied for and turthar agrees to remove same upon notice Irom the <br /> A ved for C stru i n Date City and to replace pubiic property damaged thereby. <br /> � _ � � �� <br /> p` �' �:l�'ll �1� ���� .�����' <br /> Si nature ol Apptic� Date <br /> everett PUBLICWORKSDEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedatStreet iB0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretG WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � Phone:2598810 CANCELLED BY THE CITY UPON ANY STOPPAGF OF WORK ON THIS <br /> PROJECT OVER 90 DAVS GURATION. <br />