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�� � <br /> �9 H t~il ��,��,�,�.w��w.r„���m�{.{ ��j/�._(/��_.v . <br /> y � � '� i,ina Droi.� (�,��1-J�-���. <br /> Dat��� <br /> � 1-3 � AnPhcobcn For v��nic Wo.h�foe "����. . <br /> °�9 H �{7 toiai Fer $- --_ . <br /> � ��+ PUBLIC WORKS PE:RMIT ,,. sq�p, �pp..a $��— -. <br /> y S ��__ %-=__— <br /> x 2p 3 ua�a���o�� _ <br /> [1Ht7 <br /> Print or Type Only <br /> � � g � � � r� <br /> 4,,, �, I �� � <._ <br /> H C . I n..n/ 7 IL� � 1`Y I �-� � <br /> z H 3 ��Y Phone <br /> � H Z Malhr.g Atltlress <br /> H H Owoe� —.. <br /> �7 N <br /> O �y � LP Phone <br /> �� � �-------- Mailing Address — <br /> APPlicant <br /> HOc�i� ��� <br /> DeScnhe PropoSPd Work � <br /> - W <br /> ���9 – .11z'r�i�«-.a�--- r <br /> Prolect AOdress UI knowN -- � <br /> AVach lour 141 cop�es of plans�o�PrOpoSed work� 0�:+`h'�o SCale and no�e�Cen�e�ine ot SfPee� �1 It'� N <br /> • ProPerty L�nes • Indicate North <br /> • Outhne and dimensio�s ol a�l ex�sting and � Show any Proposed y�ad���q chanyes � <br /> propc<ed structures on Ihe lo� � Show measuremenls <br /> • F.x�sling and p�oposed utild�es O <br /> DO NOT V:RITE BELOW 1F'�C LWE <br /> I��C'. � PERMITCONDITIONS � <br /> 1.All calls tor inspeclion sh211 be made 24 hrs.in advance•Phone 259•SB10. <br /> j , 2.All work shall be pedormed in accordance with this permit and curmnt City of Everett Design and Construction � <br /> IStandards and Specilicalions. <br /> I ��13.Call Location Underground Service 48 hrs.6efore you di,y.TOLL FREE NUMBER 1•800•424•5555. <br /> � O <br /> i =_ , � <br /> N <br /> �_ O <br /> a <br /> ' , ' 1 ACKNOWLEDGEMENT OF CONDI1lON5 <br /> I � � The unders'gned ow��er/apPlica^t here6y agrees to hold and sa��c hanm <br /> I <br /> les=_ ihe Cilv o� Everett lrom any an�i all claims for damages, costa <br /> Ii,�� ezpensea. o� .��•�ses ol action thal may arise because ol installalion <br /> \ <br /> ���� ���p and mn�r.bxnau..0 o� Ihe impw�ement or olher rigM-obway usc here o <br /> � - � / _ appiiekl�for a�d lu�tner agrees :o remove same upon not�ce from Ihe <br /> Date � ,1 a� lo rep���e public propenY damaged Iherehy. <br /> 4pproved lor Co�stru ion _ : �I ._ . <br /> / ��'� <br /> �'` �i�/" i�-r_d� _ y =_ _- _ �I �a <br /> ��— — - � `�°�� <br /> FINAL INSPGGTION Date �-,+-.rc�l ` �A���. ,�,�� <br /> Approved zs Construded �VJORK U iOHIYED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> PUB!1C WORKS DEPARTMENT 180 DA �F UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> J� BE DILIGE iLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> 3200 Cedar Slreet CANCELLCD BY T'aF C�TV UPON ANY STOPPAGE OF WORK ON THIS <br /> Evcrell,WA9gza� pROJ[CT OVER 9C »Y•'� nURAT10N. <br /> Phone:259�8810 I <br />