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� � i <br /> 4-21-92 � {,`r APR U �{ I )`���w�•'�o��36440�" <br /> Date � . :�ST�1'1`j <br /> Nind oeo� • <br /> qpplicalion Fo� <br /> PUBLIC WORKS PERMIT ����'cWoreel'ee _ <br /> ToieiFne s <br /> Less�p0� fee P�iO S <br /> Ba�ence�un 5 �� <br /> Print or Type Only <br /> 355-2079 <br /> LdITv M�r��•7nv P�l Phone <br /> Owner <br /> Mallmg Address C.ty 2i� <br /> O�mer <br /> qpplicenl <br /> MaiGng AAdres5 City Zip Phone <br /> Describe Proposod Work <br /> - W � <br /> Pro�ecl Address(il k, awnl <br /> 731 — 110th P1 SE (Lot 2 nf SP #6 911 � <br /> � <br /> Attech lour(4)coples of plens lor proposed work• Draw to scale and note Ihe lollowinp as applicable: � <br /> • Property Llnes • Centerline ot street <br /> • Inditete Nor�h <br /> • Outline end dimensions ol ell existing and � Show any proposed greding changes <br /> proFosecl atructures on Ihe lot � Show measurements M <br /> • Existing and proposnd utiliGes W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All colls lo�inepection ehell be mede 24 hrs.in edvance�phone 259•88�0. <br /> 2.All work ehell be perlormed In eccordance with this permit and current City of Everett Design end Conet�uction <br /> Standerda end Specllicetlona. � <br /> 3.Cell Locetlon Undetpround Snrvlce 48 hrs.belare you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> il O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOVJLED3EMENT OF CONDITIONS <br /> The undersigned owner/applicanl he�eby egrees to hold and snva hnrm� <br /> �`, _ less the C�ly ol Everet� irom any and all clalms for damegr.s, cos�s. <br /> eKpenses, or causes ol ec�ion Ihel may erise beceuse ot instellation <br />' �%'�C�/.,r� ���—�Z end maintennnce ot ihe improvement ar other ri9hl�nl�wey use herr.lo <br /> f L�c <br /> .w epplieA lor and lurther eg�ees lo remove same upon notice Iwm t e <br /> Approv r Cons ur,tion Date City nnd lo replece pu6lic properry dameBAd ihereby. <br /> . . <br />' � �3�� 3 7�`�l <br /> N L INSPEC 101� l� DO�e c Da�e <br /> Sig �ure ol A �� <br /> qpproved es Constructed qK AUT RILED BY TNIS P JJ-MUST BE STARTED WIiHIN <br /> �'� PUBLICWORKSOEPARTN,ENT 180 DAYS OF DAiE PERMI ,�SUED AND THEREAFTEH IS TU <br /> � 3200 Ceder Slreal BE DILIGENTLY PURSUE COMPLETION. THIS PEHMIT MAV OF <br /> , Evaratl.WA 98201 CANCELLED PY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone-.259-8010 i PROJECT OVER 90 UAVS DURATION. <br />