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Date v�mK wonu r..R,n. <br /> Applicetion For e�.o.w.. <br /> PUBLIC WORKS PERMIT ^�^�KW�^�F� <br /> Tol�l Fa� S <br /> Ls��ADa�Fsa P�iO s <br /> B�I�ric�D�a S <br /> Print or Type Only <br /> Plan Chack No: 8 3/680/0 3@PA <br /> Owner �Pgobc7lddr�a�s 2802�fIBWITT AVE p Phone <br /> Own�rt JOHNSTON PSTROLBUN <br /> T�nant� CAN COAP <br /> Applicenl propo�ed U��c ESpRfiSSO STAND p PhOne <br /> Da�c. of Nork� <br /> ESPRBS30 BTAND <br /> Describe Proposed Work _ OFFICS SBT JOB SET <br /> l►PPROVBD FOR PERMITt Dl►T6_/_/_ BY <br /> W <br /> Project Address(11 known) � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol atreet � <br /> • Outlina and dimensions of all ezisting and • Indicate North <br /> proposed structurea on the lot • Show eny proposed prading c�anqes <br /> • Ezistinp and proposed utilities • Show measurements � <br /> , DO NOT WRITE BELOW TMIS LINE O <br /> pFRM1T CONDITIONS <br /> t.All calle for Inspectlon ahell be mede 24 hra in edvance-phone 259-8810. � <br /> 2.All work ehell be pertormed In eccordance with thls permit and current City of Everett Deslqn and Conatructlon <br /> Stendarde and Specificatlona <br /> 3.Call Locetlon Underground Servtce 48 hrs,betore you dig.TOLL FREE NUMBER 1-800-4245555. � <br /> �-(' �sf7'2-i'��-zJ' sf4-•�uY1 I��Ll.�-� /�-L� O <br /> � � <br /> S�-• �,� O�z. ' �1L[����J �����e2Z`'.y — � <br /> � <br /> ,4��' �� l���.t"�'u.:., �,C�.. S r��.z��� <br /> — % 2�, �'..✓ a <br /> /�i 1�;� — 0�— Gc�Q,� . �(/��� (/�/ <br /> , c <br /> ✓ / � 2� �-Il � � � . <br /> �p ��i� GUO7!'���^���"µ ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersiqned owner/applleant hereby agrees to hold and save herm• <br /> less Ihe City of Everett Irom any end all claims for dameges, coats. <br /> expenses, or causes of actlon Ihat may adee becaune of Inatallation <br /> �nd maintenance of the improvement or other righbohwey use hereto <br /> applied lor and further agrees to remove same upon notice Irom the <br /> Approved tor Construction Date City and to replace publie property Aameged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Ppplicant Dete <br /> � PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �200CedarStreet 1R0 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS �TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> GAP�CEILED BY THE CITY UPUN ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�88t0 I {>NOJECT OVER 90 DAYS DURATION.--- <br />