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l <br /> i <br /> Ir�enu vrn��sPrrr�A ��/�. <br /> �i�? � �, , � <br /> 1810 rin� oeo� • _ jj l <br /> ApPlicalien For <br /> PUBLIC WORKS PERMIT ''°°',�:��.�"° s_ - -- -- <br /> n.�.n•�m rn�vam 5 ___ <br /> ��r�.,,�.�o�� S� <br /> Print or Type Only <br /> ��'� l-���_ ��l -4���� `�r+FE�L �Cal �183�3 <br /> �W�ef Maihny Addiess Cdy 7in Phone <br /> �L�.f7"Y) C6:P l�. ��l ,���� `J�1;E'�•_/�.� ��� �'�'3t�' <br /> � <br /> Applicant A7ailing AAdress Ctly Zip Phoneri�� � /J Q <br /> ^� (t/�C.l..l <br /> Descnbe ProPosed Work J�� — — <br /> __ --- _ W <br /> � (�!�7 - �'a,�..�.�.��:��/� l�r ''"' <br /> Pro�ect AGdress(il knownl -- <br /> Altach�our I41 coUies ol plens tor proposed work- Draw lo scale nnd note Ihe IOCowiny as applicable�. � <br /> • Property Lines • Centerline M slreet � <br /> • OuU�ne and dimensions ol all ex�sting and • I.�dicate North <br /> prOposea structures un ihe lot • Show any proposed g�ading changes <br /> • Ezlsting and proposed utifdies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.Atl calls lor inspectlon ahell be made 24 hrs.in advence-phone 259•8810. � <br /> 2.All wo�k ahall be parformed in accordance wilh this permit and current City ol Everett Design end Construction <br /> Stendards end Speclfications. <br /> 3.Cell Locetion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �u�. -�,v g� ��2��4�' CL -:�: V/ <br /> cL � /� <br /> 3� � �j��.�u.-, ,l, �jc7✓.� 7 �Arry GYAi�i�� � <br /> h �.�..-� 5' ,��� �, ,� t/� <br />� j � a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> ,� Thn undeisi9ned owner/appllcanl hereby agrees to hold and savo harm� <br /> —�— — iess the Cdv ol Eveielt Irom any and all claims lor damages, cosls, <br /> / / JJJ ezpenses. or causes ol action ihat may anse because of installation <br /> .�(/•��� �' ,^/y� and main�enanr.e of �he �mproV6men� or o�her nghPof-waV use herelo <br /> � � ����T� applietl lor and lurlher re .'to remove same ��pon nolice Irom the <br /> Approved fo�Consiruction Oate Gty a ep� �e Pu c o,�Ser dama�ed Ihereby. <br /> ���.li�� .�-��'/��d / ,{ <br /> FINAL INSPECiION �a�e ` /! �� /U� <br /> Approved as Consiructed SignaWre ol Applicanl a}e <br /> VJORK AUTIIORIZED BY THIS PERMIT MUST 9C uTARTED WITHIN <br /> everett PUBLICWOP,KSDEPAR7MENY 1B0 DAVS OF DATE PERMI7 IS IS3UED AND THEREAFTEF IS TO <br /> � 3200CederSireet BE DILIGENTLV PURSUED TO COMPLETION. THIS {'ERMIT MAV BE <br /> Everetl.WA 99201 CANCELLED BV THF CITV UPON ANY STOPPAGE OF WORH ON THIS <br /> Phone:259�BB10 PROJECT ObER 90 DPVS �URATION. <br />