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r <br /> � <br /> � __ _- -- -- "� <br /> Date�� v�eiK won.w�n. �}[ /f � <br /> aiao.o.n. <br /> Appliutlon For <br /> PUBLIC WORKS PERMIT � '��ra.i�°� . a�-- <br /> �...�wo�v«r.a • <br /> B�unaow i <br /> 7�� <br /> Print or Type Only <br /> V,G�oH �7oLci Ii.VAf G1' ���� //ew/�/ /T l�� �✓ere� �g20 � <br /> Owner Mellin9 Addresa City Zip Phone <br /> �S�--G7o v <br /> Applkent Malling Address C�ty ZIp Phone <br /> DescrlbeP� sedWo�k /1 Pi+.��/e- a l��b�tc_� 5��� /.c./CL-//� � <br /> _�� ,.�..�w r�v�c� <br /> W <br /> prpJect Addreas(if known) � <br /> Att�ch four(4)coples ot plena tor proposed work• Draw lo scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • OutHne�nd dimenslona of sll ezisting and • Indicate North <br /> proposed etructuroa on the lot • Show any proposed grading chanpea <br /> • Existinp anC proposed utilitiea • Show measurements M <br /> W <br /> DO NOT WRITE BELOW TMIS LINE O <br />� PERMIT CONDITIONS <br /> t. All calls lor Inspection ehell be made 24 hrs in advence-phone 259•8815. � <br /> 2. All work sA�ll Da paAormed in accordance with this permit end current City of Everett Design and Co�struction <br /> Sland�Ma end SpeClfiGtlOn0. <br /> 3. Csll lx�tlon Underp�ound 3ervice 48 hre.before you dig.TOLL FREE NUMBER 1•800�424•S55/S. � <br /> •� �lLW" C �/� S��d G. lc�a/� .c.�J _$c 0 r e �'►RrlcS <br /> , dr 1"��4+^�- � ,R4��w--✓orit�.s O <br /> ,S R�e�,.��.� �r G�- sJ`�, �30.6 � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicant heraby apreea to hold anO save harm- <br /> leas the City of Everett Irom any and ell claime for demapes, coet0. <br /> �_� ��� eapensea, or ceuses ol ection thet may arise baceuse ol Installellon <br /> end maintenence of the improvement or other riphbof•wey use hereto <br /> i applied for and turther egrees to remove same upon notica irom t�e <br /> Approved for Conatruction D81e Cily and lo replece public pr erty dameped thereby. <br /> /v-� ' <br /> � � �'� �Z.�.� 6 3 � <br /> PECTION � 1e D e <br /> Approvsd sa Constructetl Signeture of Applicanl � <br /> ��� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:2E9•8875 PROJECT OVER 90 DAYS DURATION. <br /> � � <br />