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�e�e-�� "—V J � PUN¢Worh�Pvm�l• <br /> I " <br /> Applicatlon For oieo o�vi.• <br /> PUBLIC WORKS PERMIT P�^�KW�.�.�.� ' <br /> ,a•.��.. •-- <br /> Les�AOnl FnP�itl � <br /> Print or Type Only 8.�.��.o�. s <br /> PN,�-�����/" �._1-pt7-U l� �J.L�`�. kUt:.,�E'� �0.�`�� �� / �5��}l� <br /> Owner Melling Adtlreee City Zip Phone <br /> C7��ST11�- � 4�L"S� 5� C U��E'TT ��X 3-0`�( ?'; �- �[(r.:� <br /> Appllcant MeILnSi Adtl�esa Cdy i� Phone <br /> Deecrlbe Propoaed Worh C ' ���'�1 1'( ���•�J�N c/ T/c, � LJ r�C (,�I��� _ <br /> �(11 �I�f�G�l_ �()4� 1� �'•�S �y/5 1 7 t S 1 \ �. <br /> . � <br /> ProlBct Addreae(il known) �JC� E. pF N.E. Cb.e C� %Y A�F S.E £�LX� TNST, s � <br /> Attach lour(4)coples of pinns lor pruposed work� Draw lo scale and note the lollowing es apphcable� � <br /> • Property Lines • Centerline ol streel /� <br /> • Oulline end dlmenaiona ol ell ezisfing end • Indicate Nort� ` <br /> propo9ed 9�rUCmree on Ihe lot • Show Any pr000snd yradnig changes <br /> • E�leting end proposad otilitiea • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDI110NS <br /> 1. All call.�for Inapectlon shAll be mede 24 hrs. in edvence� ,�hone 259•BB15. � <br /> 2. All work ahell ba performed in accordence with Ihis permit antl turrent (.ily ol Ererelt Desig:,nnd Corstructlon <br /> Stantle�ds end SDecillcaflons. <br /> 3. Cel!Locetion Underground Service 48 hrs.belore you dig, TOLL FHEE NUMBER 1•800�424•5555. � <br /> � � �� � O <br /> , ,� �� � /�� '/ � ,� ��� <br /> � - r I-- <br /> ' ��� � � � ��' �� � �`"�` V� <br /> % <br /> �� � ���� ., l�Fl�� ✓ ��,�,'�'� s � <br /> �� � s� �' ����,�� a <br /> ACkNOSRt EDGEMENT OF CONDITIONS <br /> 7he undersigned owner/npplicant her.:by egiees to holJ end save ha�m� <br /> � -- --� less tY� Gty ol Evereli Irom any end ail cleims loi 9emeqes, coets, <br /> expeeses, or causes of ec6on thet may erise bnrauea ol mslallation <br /> and mainlenence M the impruvemenl or olher righFobway une hereto <br /> apphed �or antl lurihnr egrees to remove same upon notice Irom iha <br /> ApProved lor Consiruclinn Date City and W replace pubhc property dameged Ihereby <br /> � <br /> FINAL INSPE(.TION Dete �� `� � ,�/'li � ���`�_ <br /> Approved as Canstructed Signa ure�I App canl � Dnte <br />� everett PUBLIC WORKS DEPARTMENT WORK AUTHO ITED BY THIS PERMIT MUST CE STARTED WITHIN <br />� � 3200 Coder Slreet 190 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eva�etl. WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone� 259�8815 CANCELLED BY THE CIt Y UPON ANV SiOPPFGE OF WONK ON THIS <br /> PROJECT OVER 90 DA�S DURATIUN <br />