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�.� . <br />oatel I-��i� U <br />. . .� . , <br />AppllcatlonForTO °OSTIN�� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� P'� 8/�� <br />Address <br />Puel¢ Wod�Parmll •� ��j�` �� �V� <br />8 / �' — �� BIUp DaD� � ��!�i^L2f � <br />PuEI¢ pn� Fsa <br />To1�IFea a � <br />Uu �oo� F.a vua � <br />en.�a. o�. : v= ' — _ <br />%1 LIi�Epr <br />Applicent Meil�ng AdCreSs City Zip Phone <br />�5•'l0i ?1 1�:5'.�FM �L�Aflo�3�1 � a % <br />Descrioe Propc:^d Work ��g%N S�� / <br />�..:o . <br />�.e� us. r,o <br />L �� • <br />SO� —/✓3=`�Ft', S_E B SkCH f4.50 <br />Prolecl AAd�e78 (if knowN — pli;q,p,� t20.G0 <br />Altech lour 14) cooles of plens for proposed work - Draw to scale end note the lollowing as eppliceble: ����y!6 <br />• Property Lines • Cente�line ot elreet {,�TER �fi��•� <br />• Outline end dmenaions a1 nil eaisling nntl • Indlcate No�th p„�y <br />propoaed slructures on the lot • Show any proposed gradi fitt,jr.�s' <br />• Eaiating and p�oponed utAillee • Show measuremenls � S�•� <br />crmt•T t��n_r�1 <br />CHEC�; i�294.19 <br />PERMIT CONDITIONS <br />1. All calls for inapecllon ahell be mede �4 hrs. la edvence • phone 259•881 O. <br />� 2. All work shell be peAormed hi eccordence with Ihis permit end cunenl City ol Evsrett Deslgn end Conatruction <br />'� Standerds end Spaciflcalions. <br />3. Cell Locetion Underground Sarvice 4P hrs. belore you dig, TOLL FREE NUMBER 1•800•424•5555. <br />11/ �-'.�•`)1 <br />' ft l' 1� 1� 1`�(� ' <br />AOProvad 10 . Construc�ion Dat <br />C/ �"� _ fS <br />F AL CTION Dele � <br />Approved es Constructed <br />everett PUBUC WORNS DEPARTMENT <br />� 3200 Ceder Sireet <br />Everelt WA 98201 <br />Phone: 259�BB10 <br />The undersigned owner/appiicanl <br />less the City ot Everetl Irom erY <br />expenses. or ceuses oleclion 1 <br />end aintenence oltheimP'o ei <br />ap eA1 or nnd lurl er aqree tc <br />C� vlary� io replace��ubliq7p per <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />JyOF CONDITIONS <br />Feby egreec lo hold antl save harm� <br />and all claims lor dameges. cosls. <br />may a�ise because ol inslallaGon <br />nl or olher righ��ot-wey u5� herelo <br />emove 6eme upon no�ice Irom Ihe <br />�amnged thereby. <br />S• ���'7/ <br />Dale <br />WORK AUTHORIZED B?HIS PERMIT MUST BE STARI'ED WITHIM <br />iB0 DAYS OF DATE P RMIT IS ISSUED ANO THEREAFTER IS 10 <br />BE DII IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLFD BY THt CITV UPON ANY STOPPAGE OF WORK ON TFIIS <br />P9qJFC7 OVER 90 UAYS DURATION. <br />