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1�_5'_,� - �� z�4a <br /> �8�e Pubbc WorM P�mll• <br /> / <br /> APPlicatlon For eieo oeo�...::'�- �' , <br /> PUBLIC WORKS PERMIT P�OTo11�eFee , <br /> len ApO�Fee P��U � <br /> B�i�ncs Oua � �5�• s'3 <br /> Print or Type Only —" <br /> l� � /Ir�i�l a�c �1,}tzu�1 ��'r�zr� i��z�� /� ��r�C��'� ���nf/ .���� .3�1/ <br /> Ownar Me ing Addresa City Zlp Phone <br /> L� <br /> / - �� `' ��� ./ ' �� i �� �- •)Y" � <br /> � pPp( B�� Melling Add� ss City Zlp Phone <br /> Deecribe Proponed Work <br /> � ' / ' l � <br /> W <br /> , ���>� � <br /> Prolect Add�eee(II known) ���^ � �" <br /> Attech lour(4)coplea ol plene lor proposed work• Drew to ecele end note the Iollo.vinp ea epplicable: � <br /> • Property Linee • Centerline ol etreet � <br /> • Outlina end dlrr.eneione ol ell exlallnB and • Indlcete Morth ,,,,� <br /> proposed 6tructuroe on ihe lol • Show sny proPosed greding chengee <br /> • Exletinp and propoaed utllltlee • Show meaeurements � <br /> DO NOT WRITE BELOW THIS LINE O '� <br /> PERM�T CONDITIONB ' <br /> 1. All calls lor mepectlon ahell be mede 24 h�s In edvence•phone 259•8816. � I <br /> 2. All work ehell ba perlormed In eccordence with thle permil end cunent Clry ol Everelt Deeign end Conahuction �, <br /> 8te•iderde end Specllicatlone. <br /> 3. Cell Locetlon Underg�ound Servlce 4B hrn belore you dlq.TOLL FREE NUN.BER 1•BOO-424•bS56. � <br /> TO B.� CO�/ST•ev�Tr_=O f�iE' /JPP.E'O?�,�D jalF�/-S O <br /> ,Z�7L� 7 -/7- B7. <br /> _,,.. .. :��;'r 1; . ,��r', OU��ur.' r. � <br /> ; � � � <br /> � kUJ09[1664 O <br /> Pf�W F[: 434.,�r, <br /> IWINJ° SGIJ.51 <br /> ,,,,� �� ��,,�.�,-, a <br /> ACKIVOWLEDGEMENT OF CONDITIONS <br /> The undorsigned owner/epplicant her�iby egreas to hotd end eeve herm- <br /> lesa tha City ol Everett Irom eny eni ell clelmn lor Jemeges, cost& <br /> expenaes, or causes of ecllon that may erlae bacause ol Inate�letlon <br /> B�G�87 end malntenence ol Iha Imp�ovemant or other righhol-wey use hereto <br /> /��L� eppllad lor and lurthe� egiees tc remove aeme upon notice from the <br /> Approved for Conatr Ilon Dete City end lo rep ce pu611c property damaged thereby. <br /> �71�d ` a. � � <br /> FINAL INSPECTION Dete � Dete <br /> Approved ea Conatructed Signelure ol Appllcent <br /> WORK AUTHORIZED BV THIS PERMIT NUST BE STARTED WITHIN <br /> everetl PUBLIC WORKS DEPARTMENT 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett.WA 88201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORY,ON THIS <br /> Phona: 259•BB75 pROJECT OVER 90 DAYS DURATION. <br />