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� <br /> � <br /> DBtB�Q ( r�mK wom.r.rmn• �' 7 �" �� <br /> Applicatlon For eao.o•o�.• .l(l.�.,t— <br /> PUBLIC WORKS PERMIT °�°��F- - <br /> Tol�l FN s — <br /> L�uApo:FwP�M { �]�� <br /> B�4z�Dua ��.. � <br /> Print or Type Only — <br /> ��. SEIF�£12� C'� �.G, L2n„� 81 � vn�n J� Itil/f �.�aOG� cZ�'G -.S/D� <br /> Owner MalHnp Addrees City 2ip Phone <br /> ' p�,�,;� � <br /> F�n I � e� � Y � F� iP,�`!`�� ��a[+U� <br /> Appl n Mailing dress City Zip Phone <br /> Deserlbs Propo�ed Work ���r�n _�_�. �_,C ru .T �en n �/�i�,��a _ <br /> 7 <br /> .�320 - yEsd,� W <br /> Pro�ect Addrou(lf known) � <br /> Alt�ch four(4)copN�of pl�ne for propoaed work•Draw to scale and note the following ea applicable: � <br /> • Propsrty Lins� • Centerline ol street � <br /> �Outlins end dimensions ol all eziatinq and • Indicete North <br /> propo�ed�tnrMuros on the lot • ShoM•eny propused gradinp chanyaa <br /> • Exitthp�nd propwed utllitien � � Show measurements � <br /> DO NO W ITE EL W kl LINE <br /> PERMIT CONDITIONS O <br /> 1. All cUls for inspeetion nhell ba mede 24 hra I�advance-phone 259•881 S � <br /> 2. All work sA�ll be performad in accordance with this permit and c�rrent City of Everett Desiyn anA Constraclion <br /> Standuds�nd 9peaficationa. <br /> �3. Call Locatlon Underpround Service 48 hra before you dig.TOLL FREE NIIMBEII 1•Bri0�4�Ij.6665. � <br /> � /'-�. o�'�O�a..���� �,�.�/ / '�C- :3 y O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underslgned owner/applicant hereby apreee to ho�d end save harm- <br /> less Ihe C of Everett from any an I clalma for damapea, cost4 <br /> � exp e0. or ca s of acNon tA msy e ee becsune ol Instal:�;icn <br /> �� d maintenance o the im va ent or er N.r,ht-of•way use Aereto <br /> oved forCp� y�J Dete PPlied for and f he� a e s t remo eame upon notice Irom the <br /> �f City and ce public � pe y de aged thereby. <br /> /�(3GlL3�C/ /��F"/� ' <br /> FINAL INS TION at� �/ � r� <br /> Approved as Constr,�cted S e ol pplic nt Dele <br /> everett PUBLIC WORKS DEPARTMENT WORK AUT ORIZ D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS F DA PERMIT IS ISSUED ANO THEREAfTER IS TO <br /> EveretL WA 98207 OE DILIG TLY P RSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLED BY T E CITY UPON ANY STOPPA6E OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />