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1 . •' u��� ' . � e I• ' �1 . , • . . . '. ' \. . •Puellc WorM�MrmM• �� //D <br /> oate jssu <br /> eiao.o.w.. <br /> Applicallon For <br /> PUBLIC WORKS PERMIT °��o,:°::"' • <br /> . . u..�ovi F�.v.a � �� <br /> t B�4nc�ow { <br /> Print or Tyqe Only ppZ - 2 2 y0/ 7g�� <br /> � <br /> *0 10� 1707 IVs Q�-76 6Ntt1�, Ml1 9e174 7�t-S878 <br /> Owner MelNng Addresa City ZIp Phone <br /> Orp�s <br /> Appllcant Mallinp Addrees CItY Zip Phone <br /> Describe Proposed Work 1�lt1a► !O Oh1uK b1�lA{wn <br /> W <br /> ProJect Addreas�if known) �OOI M. fi�lno 114. - Dldq. �0-60 � <br /> Attach four(4)coDlee ol plens lo�propoaed work•Draw to ecele and nole the tollowinp ae applicable: � <br /> • Property Linea • Centerline ol alreet � <br /> •Outline end dimenalone ol all exiatlnp end • Indlcate NoAh <br /> propoeed slructuree on the lot • Show any proposed prading changes <br /> • Existlnp end propoaed utilltiea • Show meaeurementa M <br /> I L L � <br /> PERMIT CONDITIONS O <br /> 1.All ca��e lor�nsped�on ena�l be mede za nre.In edvance•pnone 25�$8/0. � <br /> 2.All work ehall be peAormed in eccordence with thle permlt end current City of Everetl Deaipn and Conetructlon <br /> Standards and Speci/iullona <br /> 3.Call Lxnllon UnAerpround Service 48 hre.before you dip.TOLL FREE NUMOE111-800�424b556. � <br /> � ,�: � �.� .. ���- , •�� � . •<</� - -'-a�% �' �`'rS� 0 <br /> `� � ��'<,,:,,� <br /> � � � � � � � <br /> 0 ^ _ D <br /> APn 11992 A <br /> . . ......................... a <br /> CITY OF E'JERETT <br /> Buildin� Divislon <br /> , � ACKNOWLEDQEMENT OF CONDITIONS <br /> a The underalpned owner/epplicenl hereby ep�eea to hold and save herm• <br /> lesa the City ol Everelt Irom any and all clalms lor demepea, coats. <br /> _� / , � � , expenses, ceusee ol action that mey aNse beceuse of Installetion <br /> and melnte�ance ol Ihe fmprovement Or olher riphbol•wey uae hereto <br /> '/���"' � a� 9Z applled lor and ludher eprees to remove same upon notice Irom the <br /> Approved lor Const ction a�e City and to replace ublic property dameped thereby: " <br /> � . -� yl/� <br /> FINAL INSPECTION Date Date <br /> ApOroved as Conslructed Sipna re ol Applicant <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 3treel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Everett WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAOE OF WORK ON THIS <br /> Phona:268�8810 ppOJECT OVER 90 DAYS OURATION. <br />� — v <br />