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� �3-4s � <br />Dete � <br />AppllCallon For <br />PUBLIC WORKS <br />PERMI <br />NGV � O ��:7V <br />Print or Typo Only TQ POSTING —.-- _ ���� <br />� I���� <br />. . . /i _ _ ♦ . M <br />C) IVubi�r. WOM� Pcrmil • ��� <br />Bltlp Dao� � — <br />vuouc Wo.ws �e� s <br />Totsl Fee <br />Lau�pD� ��eP�A f <br />8�bntt Due { 7�� <br />7�a�6 3/d d'..?92 <br />OWnor Ma�linq ANJresS ��.� ���� LiP rno�e <br />SYT�vI � ._"--"' '— _—. <br />AFpIICeoI Mailinq Atldrr.ss Cfly Lp Phonn <br />Describe Proposed Work �1.LL�._—� .�`.��laLLQif�tle���-1_� I� b�t-s�s� <br />Projecl Address Id knownl ��_���-f �S� . <br />Attech low IA1 copios ol Plpns loi Noposed wurk - p�av: lo �r,J�� .�rn1 nole Uie lonowmg d6.lpplif.Tb�P <br />• Pro�er�y Lines <br />• Outhne and dimensions oi all e�ishng an:1 <br />proposed s�.uctures on Ihe lo� <br />• Fxisling nnA proposed ulilities <br />• GoMerlme nl Slreet <br />• Intlicn�e Nmth <br />• Show any proDoscA grntling r,hnnges <br />• Show mnasuremenis <br />PERMIT CONDITIONS <br />1. All cells lor Inepectlon ahell be mada 24 hrs. In edvence • phone 259•8810. <br />2. All work ahell be peAormed In accordance wilh ihia permll end current Clty ol Everett Deeign end Conetr�^tlon <br />ards end Specilicetlone. <br />ocatlon Underpround 8ervice 4d hre. belore vou dig. TOLL FREE NUMBER 1•800•424•SS��. <br />, C vi L Jii� !�^�E ��e o�On2 ��" Q�Prove � <br />y�� p�Q.�s ����d �//�s <br />ACKNOWLEDGEMENT OF CONDITIONS <br />lh�� u�dwsiqned <br />- --- --- -"- -� Icss Ihn CdY OI <br />� / I rwpensrs or ta� <br />� <br />��,,� /�- <br />FlNAL INSPECT ON Date <br />Appioved as Conshucted <br />�PUNLIC WORKS DEPARTMENT <br />3200 Cetler Slreet <br />Everetl, WA £8201 <br />Phone:259�8810 <br />o ipphrd lor <br />� Gty .lnd lo <br />I � <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />� <br />a <br />iwner' OPlicxnl he�eby agrees lo hold and save harm� <br />yB �I If m any and all claims �Of dameges. cos�s. <br />� s ot � n thal may ense becnuse ol inslallalion <br />of i provement or o!her npht�ol-wey usn herelo <br />�r .r 9rees lo remove seme upon notice Irom the <br />ic prone�ty damaged thareby. �I ��� �� <br />W K 2E0 BV THIS PERMIT MUST BE STARTED WITHIN <br />� F DAtE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />B' ILI NTLY PURSUED TO COMPLETION. TMIIS PERMIT MAV BE <br />CAN('ELLED BY THE CITV UPON ANY SiOPPA6C OF WORK ON THIS <br />PRO.IECT OVER 90 DAVS DURATION. <br />