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u 9 _i <br /> ZO / ic I ppbl�cworkaPe�mit• / /� /�� <br /> � TO POSTING_ �—ZZ-a � <br /> �8t8 BIOq Oeo�.• �� 2 6E+� <br /> � qpplication For <br /> PU�LIC WORKS PERMIT P�OIicWorMSFee s <br /> Tolel Fee <br /> O ` Lev�Go� Fee PsiC S � <br /> � O p p - - Belence Due s 3/3 � <br /> m 1� O � O VMS <br /> Print o�Type Onlya 3 � m r,; oN 0 <br /> � i a� p M N 1I7 <br /> �,�y M~ [� � P M <br /> Lk�T OF � 'Q � ~ Ci[y Zip Phone <br /> Owner � �� � ��� �'�r;�s <br /> � c�°i ��R'�93 L F� �o^.wf,e Wy 9B 2 57 f�6�o - 3//S� <br /> �iA/LAP TO�/�t/6 Zi Phone <br /> qpplicant Mailing Address �'�1' P <br /> Describa Proposed Work <br /> /ICL[7GQ�t. �t/Q�s�E� /�'iai� Q�"OUnv 1�YODc�,S�� <br /> q�".f¢I' [ '�i f <br /> W <br /> Pro�eet Address(if known) � <br /> rrCfFfi�rc��- .3000 Souf�J �e ri-�,na L � <br /> g�.; — <br /> Attach tour(4)copies of plens for proposed work-Draw to scale and note the followin applicable: � <br /> • PropertY Linas • Centerline of street <br /> • Indicate North <br /> • Oulline and dimensions of all exisling and � Show any proposed grading changes <br /> proposed structures on the lot � Show me35urements M <br /> • Existing and proposed utililies W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1,All calls for Inspection shell be made 24 hrs.In adva�ce•phone 259•8810. <br /> 2.All work ahall be peAormed In accordence with ihis permit end currxnt Cily ot Everett Design end Construction <br /> Standarda end Spedf�oat�one• � <br /> 3.Cell LocatiOn Undnrground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800�4Z4'5555. <br /> '� C�7��f To 'd�- DGY✓fi/°f.,� R PN AITAf,l�FO. O <br /> � aronCe 6�fwe��i <br /> S, /�9ainf*i%� 4 /�•n��nv.n a� 2v of Cle � <br /> ,fj� qe� tualer main Loc'nton 4.,d ,�� P�o�scd 6a��fir �wG�y • <br /> (, ALL �✓O�� SH9LL B6 DoN� PE� CiTfr oF EVE�c'.E�l S7Aro.9�9�eDS. � <br /> r �f! ASi9ui�T OF T�E WA�E'E fn�iN /S RF_a;v�,e�p %o BE O <br /> rSOdM/7l�D � THE c�ry c��rN�.� 3o days A!'�e.- -f�he � <br /> /iVSfa[CQ fie n /S fi+rnf7le t . <br /> 8, A /S'W�er _F/JscmENT Ta Tf1E ��T jop�' Tivf NEs✓ ld�9TEL <br /> MA.�✓ L_^CATi�.✓ n�U� � P't'OL'��'�� � �yEACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City ot Everelt from any and all claims for dameges, costs. <br /> expenses, or causes ot aclion that may arise because ol instatlation <br /> _/j. /�� ! and maintenance ol ihe improvement or other righl-of-way use hereto <br /> �?��J� ✓/�� applied for and lurther agrees to remove same upon notice Irom t�e <br /> Approved 1or ConS�uc io Date City and to replace public property damaged thereby. <br /> � /� ^z �— 1� . <br /> FINAL IN3P TION Date Date <br /> Si na�ure ol A licant <br /> Approved as Conslructed <br /> WORK AUTH 12ED BY THIS PERMIT MUST BE STARTED WIT I <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> 3200 Ceder Streel BE DILIGENTLY PURSUED TO COMPLET�ON. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS <br /> _f <br /> Phone:259�0810 pROJECT OVER 90 DAYS DURATION. <br />