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� � 5 <br /> A� x � <br /> y�� . p��� �� � <br /> ' oumm wo��c ae�m��. � 1 f--� <br /> ft f. Date�7$�5�1 eiea o�o� . _�-s-l�u�p�- - <br /> y � ' Annlicaticn For <br /> � y� PUBLI� WQRK� RERMIT °°°�„'"o„°`�` 5--- - <br /> lo�M rco <br /> � O � l l TS Ap01 i nn Pn.J S_ <br /> H C7 �,w��on�,�. S �iJr� -- <br /> Print or Type Only <br /> �� g <br /> (�]V n <br /> � y� -� � ►- - r� Z�� �zd�l a.sa-i�go <br /> � . f� �Ar/i, �-�_N��_>�ddress C�y L o Phone <br /> F„� y Ownei <br /> y <br /> H �, <br /> C'�C7� 3 �. Phore <br /> [�i r ApDlicant Mailing Address �'�Y Z�P <br /> H OL+1 1 l �q <br /> Cyi� �o�q � 7� LIv� �, /�t`f`,�P - <br /> Descnbe Proposcd Work �— <br /> W <br /> 2�!�= ��%-��v �— <br /> Pro�ed Adtlress(il knownl � "-�— � <br /> � <br /> Attach lour 141�opies ol plans IOr P�opOSP.d w0�k� Draw to sCale and nole ihe�o'luwin��as .,OP��r,:�bin� � <br /> • Property Unes • Cenierlire c`sheet <br /> • Outline anA dimensions o�ail e•isting and • Indica!e Norih <br /> proposetl structures on the lot • Show any proposed g�atling chanqr:s <br /> • Existing and proposed util�ties • Show measureme��Vs /� <br /> W <br /> - .. � DO NOT WRRE 0[LOW THIS LINE O <br /> ��' PERMIT CONDITIONS � <br /> 1 1.All calls lor inspection shall be matle 24 hrs.in advance•phone 259�8870. <br /> 2.All work shall te pedormed in accordance with this perm'•and wrrent City of Everet�Oesign and Consiruc;ion <br /> _ Standards and Specilications. � <br /> ' �' 3.Call Location Underground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•424•5555. <br /> �� <br /> i i�- . !-i<����c, l cT ►�1u�j 6C_ fl�i r�i nti��L� �,t' � �tic�de3 Ccr,,�n�"'�.K 71:i�) O <br /> ,�7 �� <br /> I `��. _.l./\'j`; ,1�" /�,-'±'j+�-rkGT iZ��L� ��vc.`�„ <{ �cnn��'i\-+.'.lL'C7, � <br /> L (l�-r51'Itl) �'I�"'t �1t VI(�'i�� 'j���l � Cc � Y"'.�C. . Y/� <br /> �1�+ O <br /> �ia <br /> �1�� <br /> I � �CKNCWL[DGEI.IENTOFCUNDIilONS <br /> �j '�� n� ) The undere,gned owner/aUP�icant heret�y agrees tn r�7 and sm�e h�rm� <br /> L �� les5 Ihe l:ity o� Everett Irom any and all clainis tar damages, costs. <br /> �^� eapenses, or causes ol action ihnl nay anse 6ecause of inslallati<�n <br /> / � n�j�� „ /1 � / . �,C] and mainlenance ol ihe improvemeN or other righl-ol�way use herelo <br /> � <br /> �'� �� � u —� apPlied fui and Imther agrees to remove same upon notice irom t e <br /> Approve �or Consfr on Da�e City anA to r lace puUl��o damaged thereby. <br /> /�-' —/ 1�=.�-s" � � ,.J ,dd,/c�5. <br /> FINAL INSPEC710N ���� Date <br /> Approved as Construcled Sion ylre ol p4cam <br /> AUT ORI2ED OY THIS PERMIT MUST BE STARTED WITHIN <br /> �everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PER�d1T IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarS�ree1 BE DILIGENTLY PUFSU[D 70 COMPL[TION. THIS PERMIT MAY BE <br /> EveielC WA 9fi201 CANCELLED BY TNE CITY UPON ANY STOPFAGE OF WOFK ON 7H15 <br /> Phonc 259�8810 PROJECT OVER 90 DAVS OURATION. <br />