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e S � (C� r�ei��wo�k,c«rm��.. po_ /7{�_—_. <br /> Applicatlon Foi emo o.ui —__— — <br /> PUBLIC VIIORKS PERMIT ��"������,�.��a — <br /> ro����.� s_ <br /> tese npni rer mm� S_�__ <br /> �rint or Type Only � ,� BeinnceDuc S �DO� <br /> �' iz .,z �''r(r�S'3 <br /> / „�'� � � �c%S"��� ��� � 1�.Q'�-n,,�,i1� �r�� �J �� � � 2 5zj—(o << 1 � <br /> Owner Mading Address City Zip Phone <br /> S�mE_ <br /> Applicant Malling Address Clly Zip Phone <br /> /� `1 i <br /> Describe Proposed Work �K� V�–�w�n•�y-��� _ � <br /> � <br /> W ! <br /> ProjeciAdd�esslilknownl � 80� W'�Trnn2E __ � � <br /> Attech low(4)copies of plans tor proposeJ work� Draw to scale and note Ihe lollowing as apU�icable: � � <br /> • Property Lines • Centerlinr. ot street � I <br /> • Outline and dimensions of ull existiny antl • Indicate North <br /> proposed st�uttures on Ihe lot • Show any prcposed greding changes � <br /> • Existing and proposed utilities • Show measummeNs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cell6 for inspection shall be made 24 hrs.in ativance•phone 259•8870. � <br /> 2.All work shell be peAormed in acaordance with this permil and current Ciry ol Everett Design and Construction <br /> Standards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.tefore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 5! ����.��a� �u�.w c�irux�y i <br /> A O i <br /> J'r VG.`✓- Gcc� 2i�d'� p./1emJ7X �[Oxc'i. �y 4��� /f,e�usv � . <br /> ��Q�r[,l�.C�c.�v ..l.r/[-�/!/ C3�/2.cc.�ec�l� 4�0/7,0� � . <br /> (o, .rClEiees��,(6�i c2 �hZ�G4�� .�`r�/ �''�v,...�.�a.Lv E�sn a�,+. J <br /> f'.c..L.-� c�ozl� (,s9—BBiv� ,aiuo�'✓i� ll:zearf 000alloso7 � <br /> .S��d � ,c� ,�,�o� � n000soz� a <br /> o�u�r :�o.00 <br /> c�a; s�o.00 <br /> � AC OWLEDG[ME T OF CONDITIONS <br /> � The undersigne wne�/applica ereby agrees lo hold and saee harm� <br /> less the Clly veretl Irom and all claims for damages. cosls. <br /> e•penses. or e ses ol aclio hat may arise because ol installation <br /> c� �y D and ma1Ne a c. ol ie im emenl or otl?er righ4of�way use herelo <br /> applied lo a lurt er ag s to remove same upon no6ce Irom the <br /> Approvetl tor Constr tion � � �e �iry an e ac ubli operty damaged theraby. <br /> �� '� - ��° �' ��1� ls � <br /> FINA PE TION Date � <br /> App�oved as Gonsiructed � Signature ol Applic �t Date <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUS7 BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everctt.WA 90201 BE DILfGflNTLV PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br /> Phone:259�8P10 CANCELLED BY THE CITY UPON ANV STOPPAGB OF WORK ON THIS <br /> Pf70JECT OV[P 90 DAYS DURATION. <br />