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t <br /> i <br /> , <br /> , <br /> Date��25� l � ��. ��. �..����.�.���C. � p�°..Op'- S/ _ <br /> Applicahon !-m �°°U oe°� . _Q_]�! o o�___ _._ <br /> PUL�LIC VilORKS F�ERMIT P���ToipjFp�F�� : ---_ <br /> lrss Ant� fee Pu�i S— <br /> Print or Type Only �,.,�,,�=�m�� S -�� __ <br /> 1 <br /> 111a1 �1w1 �-.Sna, fti ��.�, �.�SS2 Lo�r� .f�e✓ens �iF15Fr (053 -.2Uz5 <br /> Owner Mallinc�AAdrAss Cily Zip Phone <br /> SnMe <br /> Applicanl �'�iliny rdArrss Ctly Ln Phone <br /> Describe Proposed Work �"I [�U� S�/' C�0 / l3 LQI.f[�i'1 /"��(� Q_ <br /> - - /; n W <br /> Praject AAdress(il knawn) `7�� -��� {� /"-� S� � <br /> Attnch low(4) copies ol plens tor proposed work- Draw lo scale�nd note the lollowing as opplicable: � <br /> • P�operly Unes • Cante�line ol sVeet � <br /> • Jutllne and dimensions o�all existing and • Indicale Nor�h <br /> p�oposad slruc�ures on�ha lot • Show any praposeA grAding chan�es , <br /> • EKisting and proposed ulilities • Show measuremenls � <br /> UO �OT WRITE BELO'N THIS IINE O <br /> PERMIT CONOITIONS <br /> 1. All cells for inspection shall be made 24 hrs. in advance� phone 259•881 5. � <br /> 2. All work shell be perlormed in ecr,oMance wrth ihis permi� end aurent Cily ol Everett Design and Conslruclion <br /> Standard�end Specilicalions. <br /> 3, Call Locotion Under9round Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•8C0•424•5555. � <br /> :F FU$� Il'. URAIhIAGE SYSTEM � <br /> r�7 r;�/q(�� L'HANGES MUST 6E F�� � <br /> t; �qp�ik:� 7 N5F`E"CTOR. � <br /> i`TTY 9TkC:FTS CLEAIJ AT ALL O <br /> il1 WATFR E.�OXF.� TO GF:r�" � <br /> ACV:IJOWLFDGEMENT OF CONDITIONS <br /> Thn umJersiqned cwne�/applicnnl hereGy egraes�o hold nnd save heum� <br /> '--�-----"�------�-------------�------.". I, .:��. ;ne CiIY ol Eve�e�t Irom any nnd all cleims lo� �amages. costs. <br /> � �..penses, or ca�ses ol action Ihal may nrise bacause ol inslallaiion <br /> � anA mamtenancn ol the Improvemenl or other righl�ol�way use heieto <br /> ' ' �� � b�' �� apFlled for and lurlher agrees to remove sume upon notice Irom Ihe � <br /> r_ , . <br /> Approved lor Constructlon �� � D�� City and lo repincr pubhc p�operty damnged ihereby. �' <br /> /i c`. � <br /> � 1 i ` <br /> FINALIMiPECfION / /Date �--��" �,L�i�l �, J � <br /> _ _ � 0 � <br /> Approvud es Constructed Signalu�e o�ApPlicent Date <br /> pyp�p�� PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED BV THIS PERMIT MUST Bf STAR7ED WITHIN <br /> � 3200CedarStreet 1BG DAVS OF OATE PERMIT IS ISSUED AND THEREAFTEP IS TU <br /> Everet�,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. iNIS PERMIT MAY B[ <br /> Phono- 259�8F315 CANCELI ED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJCGT OVER!70 UAYS DURPTION <br />