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Dat�?_���Z <br />i , AoplicnUon Por <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />V���i�cN�or��l`ermil• �y�_/ <br />mea o.m • <br />n�e��<wo�..r.. s <br />roun.e <br />�u� �ooi r.. n.�� 5 q� <br />e,u�<.o�e S�SL�O <br />v0 Z - � 2Z yo/s83/ <br />Qa6ft� Gf�EBB 53•G• l�eh'EfEa�< �✓F�:r Yf3Y�3 v55-oi�/z— <br />Owner MaJm9 AOtliess �.iiy Zip P�onc <br />�--��}vr�[ G <br />APPIi[ani Alailin9 AOtlicSs GIY Zip <br />Descrm� ProposedWork ��LL /�AZ�' / /���'�C x /5L� <br />Pmject Atl�ress bl knownl `5/g m� v <br />Altac� low (A� c00ie5 el pinns �o� pmpo5e0 wo�h � D�aw to sca r nnE n0te I�C IOIIOwing as apphwble. <br />• Pmperry Lines • CeNerline ol street <br />• Oulhne nnd dimenslons of ell eaisiing antl • Inaiw�e Yoit� <br />p�000si�d siro[lures on ihe lot • Show any pmposce graCinq t�nnges <br />• Exisi�ng and proposed uldities • Sho.v measmemenis <br />PERMIT CONDITIONS <br />1. All talls br inspeclion s�all �e matle 24 �rs. in ativanca � Ohone 259•8810. <br />2. All work slinll be pedormotl in accortlanca wilh Ihis permil antl twrent City ol Everett Design and Constmclion <br />Stantlartls and Specifications. <br />9. Cell Lotation UndmBwuntl Service 48 �rs. bebre you tlig. TOLL FREE NUMBER i•800•424-5555. <br />� �.QC'�l �[ � .���£rr.Yi� Cco� !��-.N C-E�Ic-..� 2�� �'�� �riCr � <br />✓ <br />�-�J/�il l�i� 7 /a/92 <br />AnP�ovea lor Ca�;t uchon Dato <br />�.:�� �� �r-9� <br />FlNAI INSPECTION DaIC <br />Approvetl as Consirucletl <br />PUBLIC WOFHS DEPAPTMEIJT <br />J200 Ce]nr S�reel <br />B�eie�l. \YA 98201 <br />ppone 259-8010 <br />ACKNON'LEDG[MENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />Z <br />O <br />The un0c�siynee/ ownei/aVPlican� �eicUy a9mes �o bo�tl and save �arm� <br />Iess Ine CiIY ol Everetl Irom any ann ail claims lor tlamages. cosls. <br />e.nens��s. or causes ��4'�L'�because ot inslallation <br />antl maiNena�ce o� ihe Improvemenl or Olhe� ng�DO��way use �ere10 <br />applietl br and lurl�ei agrees Io remow Sdme upon noi¢e �mm Ihe <br />Ci�y antl IO �eplace put+Lc pio0etly elamage I�C�+by. <br />�.�`� r� o.,� <br />S�gnalme ot Ppo�manl <br />WORK nVT110i7�ZED BY THIS PEIiM1T MUST BE STARIED WITHIN <br />I80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15 70 <br />B[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />(;nNC[LLED BY THE CIiV UPON ANY STOPPAGE OF IYORK ON THIS <br />PROJ[CT OVEH 90 DAYS DLIPATION. <br />