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- I <br /> Date��`_�� � ��.,�� ,v�,.,�.,.,�,�. - --Z- _ <br /> � / ` K - <br /> uiau onoi . G.Cl <br /> Apphcation FOr <br /> PUBLIC WORKS PERMIT PunioimfneFee S -- <br /> . �>�,�,� �����.��, s - <br /> �., , . ., , s — — <br /> � __ . ---- <br /> Print or Type Only — -- -- -- -- -- <br /> �°��C����n�r►���' �{�L�I��I� � (7�• f.r,����� '1Y�1��� � � � � � i���l <br /> ---i �J_ <br /> OwnBr Mailing Ad re 5 Ciry !�� { hono <br /> `�APp���y� MaihngAdd�ess Cily 7ip � Phnnr <br /> Describe Proposed Work <br /> _�._ Sn�u�2 � I Y21 '=� R�}�iEl✓�S— <br /> ----- - _ W <br /> Prolect Address�i�known) �� �� )1�. � �.` -- � <br /> Attach fom�4) eoplee�ol plans lor proposed work-Draw to scale antl note ihe lollowing as npplicable� � <br /> • Prope�ry Lines • Gentedine ot slreet � <br /> • Outline end dimeneions ol all existiny and • Indicate Norlh <br /> pioposed st�uctures on Ihe lot • Show any proposctl praAiny chanyes <br /> • Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRI'iE AELOW THIS IINE O <br /> PERAAIT CONDIT'ANS <br /> 1. All cells lor inspection shall be made 24 hrs. in edvancc� 4�hono 259•8815. � <br /> 2. All work shall be pe�lmmed in eccordanco wilh ihis permit and cu�ren�C�ty ol Everetl Desi9n and Conslruclion <br /> Slandards and SpeciLcetions <br /> 3. Call !_ocation Underr,�rom�A Service 48 hrs bebre you diq. TOLL FREE NUMBER 1-800•424•5555. � <br /> /�'/j%' iC Ci/c�'��/u� i,E.. ��.ii %✓JT i(��(��i.Y/_'rl� /['�-G•a��' O <br /> �! '^ <br /> �f' <br /> C� <br /> ��. <br /> nckNo�virocr:n�rNT or coNuinoNs <br /> f ne unAersiqned owneNapphcant �'�orehy a9rees lo he�d and sa�e harm� <br /> ------------ �----- i�•ss the City of Everett from any end all claimc for tlamag<.s. costs, <br /> e.uenses, or causes ol acGon that may arise because o� irstallatinn <br /> antl maintenance of the improvement or olher npht�o�-wny �5� herelo <br /> apolir.d Im and lurttier ag�ees to remove same upon nohre hom Ihe <br /> App�oved Iw Construction Da!e I City end Io replace publiC p�oporry damnged �heirUy <br /> FINAL INSPEGTION Date — - �-.-..-..--�--���e, . . <br /> Approved as Consl�ucted Signaturo ot Applicant <br /> WORK AU�iHORIZED BV TH13 PEFMIT MUST 9E SfAfiTED WITHIN <br /> �•vrrrtt PUBLIC VYORKS DEPARTMENT 1B0 DAYS OF UAiE PERMff IS ISSUED AND TNEREAFiEFl �S TO <br /> � 3200 Cedar Sireet BE DILIGENTLv PURSUED TO COMPLETION THIS PLRMIT M.�Y BE <br /> Eve�etl. WA 9B20� CANCELL[D f3Y T11E C11V UPON .VJV ;70Pf'AGE Of WORK ON TFIIS <br /> Phone- 259�HH15 pROJFCI OVEH '�0 [��YS f1U(3ATION <br />