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i <br />� p8j8__��� Pubi�r Woas Permn• <br /> Applicntion Fo� A��e �Pm • �� <br /> PUBLIC W4FiKS PERMIT rueTm�iF„�r�� s <br /> �ee��nn� F�•Pem S <br /> Bo�enre our 6 <br /> Print or Type Only <br /> mo ��r�t� ���� �m� sy- ��,� � ��� �.�-����/ <br /> Ownar Meilmg Addrass G�ilTy Zip Phone <br /> �.1���! l,l�T 0�.1�Q3��_� <br /> % �> >�- 8�3 <br /> Applican� aihn dd:ess City Lp Phone <br /> . Describe Proposed Wo�k � �1 lSf� ��,K-/�—� <br />� — W <br /> Prolecl Address lil known� <br /> ���o �.���> � � <br />' A�tech low(4) capies ol plan6 lor proposed work-D�a�n'to scale and note Ihe lollowing as epplicable. � <br />�I • Property Llnea • Centerlina ol street � <br /> I • Outline end dlmensions of ell exiatlnp end • Indicele North <br /> p�oposed slrucl��ea on the lot • Show eny proposed gradiny chenpes <br /> I • Exisling and proposad utilities • Show mensuremenls � <br />� DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All cells lar inspection ahell be mede 24 hrs. in aCvance- phone 259•881 5. � <br /> 2. All work shell be pertormed In accordence with Ihls permit end currenl City of Everetl Deslgn nnd Conslruction <br /> 3tanderds and Specificetiona <br /> 3. Cell location Underground Service 4B hrs. belore you diB. TOLL FREE NUMBER 1•800•424•5555. � <br /> �ot r�g�����.o � <br /> �� <br /> ,��/, H <br /> � <br />� O <br />� <br /> � <br /> ACKNOWLEDGEMENT OF CONDI110NS <br /> The undersigned ownei;apphcant he�eby egrees to hold nnd save narm- <br /> leae the Ciry of Everell �rom any and ell cleims lor damages. costs. <br /> ezpenses, or causes ol ection �h81 rt1Ay 0/15P, bBCeUSB ol Installalion <br /> end mainlenence ol the improvamenl or other righrol�way use nereto <br /> epplied lor end lu�ther egrees �o remove sema upon nntice Irum the <br />� Aoproved lor Conalruction Dete City end b replece pubhc property dameged IhereLy. <br /> FINAL INSPECTION Oale - <br /> Approved as Cons�ructed Signeture ol AppGcanl Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> evrre�l 1B0 DAYS OF DATE ?ERMIT IS ISSUED AND THEREAF7EP IS TO <br /> � 3200 Cedar Slreel BE DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAY BE <br /> Eveiett, WA 98201 CANCELLED BV THE :,ITV UPON ANV STOPPAGE OF N/ORK ON THIS <br /> Phone 259�9875 PROJECT OV[R 90 DAYS DURATION <br />