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t � <br /> � <br /> :� <br /> �� <br /> i b <br /> � <br /> D:]ig���`!C– Fr+q " „�m��wo��.ca,mn.^�— � <br /> Applicntion For aino oeo� . J��1J 7 <br /> PUBLIC WORKS PERMIT °°°:o:��.;`°° _ ; <br /> 1-� N� Lee��oui fee ve�� S <br /> �ij Beience Due S <br /> p '� Print or Type Only • <br /> t'�' y <br /> � �� F�I�rvlcJ Thorsc�n ►�12G l�zik� r' �-�'�'r�11- `�810/ 2.5�9-/�3� ; <br /> �� Owner M2ilin�Addreas Ctly Zip Phone I <br /> � yro �'ans�-r«c,�,on 2�.�-Z/ 7� i <br /> � �� � <br /> Apphcan� Ma�lingAdtlress Cdy ZiP Phone <br /> Q � Describe Proposed Work 111P.��I e_h�, � �r� i nr, _ ���1����('.� <br /> � <br /> n• — <br /> � M <br /> � y WM _ <br /> �y Prolect Addross Ut known� _ � � <br /> L� Attach four�4)copies ol plans lor Oroposed work� Oraw lo scale and note Ihe following as applicable: � <br /> �y • Property Lmes • Cenlerline ol streel � <br /> • Outline and tllmensions ol ell e�isting antl • Indicale North <br /> propo5ed SiruCWreS on Ihe IOt • ShoW eny pmposetl gratling Changes <br /> • EMistiny and pwpo5ed u�ilitie5 • Show measmement5 � <br /> DO NOT WRITE BELOW THIS LINE O <br /> • . PERMITCONDITIONS <br /> � 1,All calis lor inspxcl�on shall be made 24 hra.in etivence�phone 259•8810. � <br /> 2.All work s�all be pertormed in accordence with ihis permit and cuneN City of Everett Design end Consiructlon <br /> � _ Standarde end Specilicali�na. <br /> � ' 3.Cell Locallon UnderOround Service 48 hra.before you tlig.TOLL FREE NUMBER�•800-�524•5555. � � <br /> �` <br /> . '' O � <br /> � .. ._ /�� �(. L� "r° 1:,1" <br /> � � <br /> i � ! � r � , �l�F <br /> y /�� y� PUBUC WOFlKS PERMIT <br /> INITIAL INSPECT(On"t Nor REOUIRED i <br /> KIRK EROOKS � BY .4�8 � O <br /> i I�" j oaTe /�-_ �-�_ � <br /> DAYr �O- 30-?2 � <br /> � <br /> � ACKNOWLE�GEMENT OF CONDITIONS <br /> ihe undxrei����d owner/applican�hereby agrees l0 hold and save harm� <br /> — less Ine City ol Everelt Irom any an� all claims loi damagas, costs, <br /> ;'� �epenses o� causes ol aclion Ihal may anse becauso oi installation <br /> and mamlenance ol Il+e improvemenl or olher right�ol-wey use herelo <br /> applied lor a�d lu�ther u�rees lo �emove seme upon notice Iwm �he <br /> Approvetl lor Construction �ale Cdy and to replaca pubhc p�operty damaged Iheraby. <br /> FINAL INSPE(:TION Dato <br /> Apprcved as ConsVuct�d Signalure of Applicam Date <br /> � PUBLIC WORKS DEPARTMENT WORK AUTHOFIZED BV THIS PERMIT MUST BE STARTED WITNIN <br /> 180 DAYS OF OATE PEFMIT IS ISSUED AND THEREAFiER IS TO i <br /> 3200Cetlar Slreet BE DILIGENiLV PURSUED TO COMPLETION. ?HIS PERMIi MAY BE <br /> Evcretl.WA 9AP0� CANC[LLED BV iHE CITV UPON ANV STOPPAGE OF WORN ON THIS <br /> Pnnne. 2FA�Rf110 �. I'{7r1JfC�OVf.H 90 DAVti DIIRP.TION <br />