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Date_i1l(..da I <br />Appllce�io� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Addresa <br />MBII�nA AOQfe99 <br />r,a��., w�.�av.�.n <br />n�na oen� . i• . � lEJ��p_—__ <br />Pume WorM� Fee s <br />To1�l he <br />lnu �p01 iae PnU d — <br />B�i�no Oun i _ <br />Lp Phone <br />up rnone <br />Dascriba Proposed Worh � �1,..��+ - <br />Pro�ect Addrees 01 known� <br />Atlnch lour 14) coplea ol plane lor p�oposed work � Draw to sr.ele enA nole the lollowing es epplice6le� <br />• Proparty Linas • Cr.ntedine ol sireel <br />• Oulline and dimensions o� ell exishi�a end • InAir.ele Nor�h <br />proposed slruc�urns on ��e lot • Show eny proposeA 9rading chenges <br />• E�Is��ng end propoaed ulilities • uhow measuremenls <br />PERMIT CONDITIONS <br />t All cell5lor inSpec�lon shall be maAe 24 hrs. in eAvanr.e - phone �rJ9•e8i $ <br />2 All work shell be par�o�med in eccorAance wi�h ihis permil nnd r.wrpnl City ol Everett Desi9n nnd Gonstruchon <br />StenderAa end Spectlications <br />3. Cell Locetion Underground Servrce 48 hrs. belore you dig. TOLL FREE NUMBER 7•e00-424•5555. <br />�� i � � �F!'/+�i. /'� � �% ,C'FC�'cY/.c't �n ���8 � <br />'b�./f Ldc�f.�� / <br />' �t� <br />Approvetl lor ConatrucUon Dwte <br />App�ovatl es Cons�ructed <br />avrrru f'UBLIC WOpKS DEPARTMENT <br />� 3200 Ceder Bireet <br />Fveretl.WA 98201 <br />Phone 259�8P15 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLE�Gf:MFNT O� CONDIiIONS <br />ihi� untlPrsi��ned owner/app4r,aN herel�y ngrer.s lo hold and sa�^ harm� <br />Ii+S; �h�• Cdy n� ivP.'2fl IlOm Bf1y 80d dll f,IqIrt15 �Of AflTB(�9fi '09t9, <br />P.RpP.�5B5. O� f.du5E5 OI 8CI10� Ih01 mAy AtISA bCCeUSB OI iO51B1�8F011 <br />end mainlenance ol the improvemanl or other �Ighl-ol�wny use hernle <br />epplied im and lurther ngrees to remove same upon nolice Irom Ihe <br />City and to repinr.e public property demaged �hareby <br />Dele t � � � `� <br />Siq at e ol A �xle <br />WOfiK AUTFIORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMITIS ISSUEO AND THEREAFTE7 IS 70 <br />BE DIUGENTLV PURSUED TO COMPLETION THIS PEFMIT MAV [�E <br />CANCELLED BV THE GTV UPON ANV STOPPAGF OF WORk C1N 11115 <br />PROJECT OVER 90 DAVS DURATION <br />