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Date3 a7 �% — '- � ouhu.Noq�ne m�l• — � _ <br /> AnPlicahon For �;�,; �„o� • - ----� <br /> PUBLIC MIORKS PERMIT P��;o;;�;,«•�_--- --- ---- <br /> le�c�nul IerPeia {i <br /> ea�.,,��.o�. 6 <br /> Print or 7ype Only = <br /> �f IGC�I)ttJ �D � — <br /> OwnBr Me�liny AdAress Cny Zip Phone <br /> AppGcant Nailing Atltlrese Cdy Lp Phone <br /> Deecribe Proposed Work �w"�"�^"` �� �C��/12liOY� <br /> � '� -- - <br /> Prolect Address lil knownl �_�— ����.+-�= _ � <br /> Altech lour(4)copies ol p'Bne 10�p�Op080[I wOrh � DrAw�0 scaln aM n01e�r�IoII,,.vmg as epp6ceb�e: � <br /> • Property Linee • Ce��terline ol slrer.l � <br /> • Outline end dimaneions ol ell exisling and • InAica!e Nnrth <br /> proponed s�ruclures on the IM • Shuw en�proposed greding changas <br /> • E�Isfmg and Froposed uiildies • Show meas�uements � <br /> DO NOT WyITE BELUW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All celle lo�Inspectlon ehall be made 24 h�e.in etivance-phone 259•8810. � <br /> 2.All work ehell be paAormed In accordanca w�th Ihla pe�mit end current City al Everetl Des�An end Conehuctlon <br /> 9tanderde and SPeclllcatlonu. <br /> 3.Cell Locetlon Unde�pround Service 48 nro.before you dip.TOLL FREE NUMBER 1•800-424•5555. � <br /> ����%CAi'fi""� ����:(Y!/r''`.a�(. /V� �7/" '`- O <br /> ' �`���� H <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEtdENT OF CONDITIONS <br /> ihe�ndersigned owner/epplican�hereGy egrees to hold end aeve ha�m� <br /> — '--- less Ihe City ol Everafl Irom any end ell clalms Ior dameBes, costs. <br /> expem,es, or causes ul adion Ihal muy eriae beceuse ol inslallation <br /> enA meinlenanr,e ol Ihe improvemenl or other righl�o4way uso he�eto <br /> xpplied lor a��d luriher aprees to remove seme upon no�ice Irom the <br /> ApD'���'d lor Conatructiqn Dele City and te raplace public property demayed thereby. <br /> ��NAt IN3PECTION Dale <br /> AUPro�ed as Conetructed Signalwe ol Apphcant Dele <br /> eve�etl PUBLIC WORKS DEPARiMENT WORK AUTHOFI2ED BV THIS PERMIT MUSi BE STARTED WIT111N <br />� � 3200Csder�lreet 180 DAVS OF DATE f'ERMIT Ib ISSUED AND THEHEAFTER IS TO <br /> Evarett.WA 99201 BE DILIGENTLV PURSUEO (O COMP'.ETION. THIS PERMIT MAV BE <br /> Phone:259-8810 CANCELLED BV THE CITV I1PON ANV STOPPAGE OF WORK ON THIS <br /> PpOJf.CT OVER 90 DAVS DURATION. <br />