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�� � _ . . . .., . vum,cwe.��ve� C� � .� <br /> .C H I��_L�-�/��� � eina Deni . �1�=-i�"_�� . <br /> y y D�te1.��—_�J � <br /> y �� Aopliwtion For t'„„�,�wons�ee $��'�___ . <br /> pUg�.IC WORlCS ��RMIT ���•�F°° <br /> �! O ussnnoi v�.ve,a S—.__--�.�—. <br /> y M M PpIPI�[!OJ9 ���T -- <br /> 1 <br /> V�H <br /> � ��;o Prini or Type Only <br /> 1 � ��/�� <' ' l'� Il")S�/l �'/�� — 1�l <br /> [�ty � � ' i �� Il- ) �1 <br /> 1 ` ��L(_._LLLtJi.r�-7 �. " � ��i )� I j }( It f 7 I i nhone <br /> � �'+1� / l� �� 1� � .� MTilin9 A�idre55 C�(Y/ ...., <br /> �• n Owner <br /> " n 1 {I�/ / �� � rrY,�s T ar���t4��� ����Ic{-{� -- <br /> � y� �� .� 1i+ 1 ����1� ��I � 1 I� 11 �L..% -L � � .� CitY LP Phone <br /> H y � Ma��irg A�dress <br /> y APP���nl <br /> � /�"�-T I L �,. <br /> g�� � , _ <br /> � '��i�-' ��-i�C_ <br /> Descnbe Propused Wo�k �-- <br /> ��� W <br /> .�� � ---- - �- <br /> proiecl Address hf knownl �'L� �� � <br /> Attach l0ur l41 copies o�p�ans for proposed work- D�aw Io scale. and note�CP^�1eWine ol stPee�3Ule� � <br /> • Property L�nes • Indicate Norih <br /> • Outhne and dimensions o�all exist�ng and � Show any propo5ed g�adiny changes � <br /> proPosed siructures on ihe lot � gi�ow measurements <br /> • Exisl��g and p�oposcA utihties - O <br /> UO NOT WRITE BELOW THIS LINE <br /> PEfiMIT CONDITIONS � <br /> / 1.All calls lor inspection shall be made 24 hrs.in advance�phone 259�8810. <br /> (:� 2.All work shall be pedormed in accordance with this permit and current City cf Everett Desg��:�nd Construction � <br /> '. Standards and Specifications. <br /> I 3.Call Localion Undergiound Service 4B hrs.before you dig.TOIL FREE NUMBER 1•S00•424•5555. � <br /> � �'-"r �/°r",,.. �/v /.s C/�t� '� -�G ' ��� <br /> � � ��� <br /> ► � <br /> � �� ( l(� ' O <br /> II ��n��1q0 0. <br /> I ' 1 � ',�� q��� <br /> i ACKNOWLEDG[MENT OF CONDITIONS <br /> � i �� The undersigned ownedapPlicant hereUy ag�ees to hold and save ha�m- <br /> less the City of Eve�ett Irom any and all clzims for tlamages. cosls. <br /> � �apenses. or causes o1 actlon that may anse because o� �seahereto <br /> o / //;'l �. , anA malntenance o1 the improvemenl or othe� ri9hPot�way <br /> A� applied lor and lurthr,r agrees lo remuve same upon nolice �rom the <br /> ��1 � / �°>"`�� 9 le Cit Y���d to replace PUUhc Pro 4r1Y da�a9ed ihereby. <br /> / � <br /> A P P� �= lo�-- onslruc � n � .� � /�� � C / 4 J <br /> '� ' l _ ° / <br /> oate <br /> �� � � Dalc � ,tuir. ol pplicanl <br /> FINAL INSPECTION <br /> qpproved as Conslruc�ed �rypRK AUTNOf�IZED BV THIS PERMIT MUST BE STAP.TED W�T�iIN <br /> PUBLICWORKSDEPAPTMENT 780 DAYS OF DATE PERIdIT IS ISSUED AND THEREAFIER IS TO <br /> Oevriett BE DIUGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> 3200 Cedar Street CANCELLED BY iHE GTY UPON�NY STOPPAGE OF WORK ON THIS <br /> Everetl,WA 99201 pROJECT OVER 90 DAYS DURATION. I <br /> Phone:259�8810 <br />