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---�-�, -T—� � . . . . . . . �. . � <br /> Date�fi � �/ v��oi��Wo.��vermfn. �� /�—/�___ <br /> Ap�licalion For e�nu oeo� � �1y��.f.](Q�__ <br /> PUBLIC WORKS PERIIMIT P������W�.�s��� ---- ------- <br /> ,o�.�F�. s ___ <br /> �.�aenoi v..v��e S _. <br /> Print or Type nnly e.�.��.o,�� s 2�°� ___ <br /> � ,�tt in�vlara�ti i �GOI Sls � l)� �1/E /1'1'.ri��� v�ilA �d.,7 �U �S9- �S >� <br /> Ownei MeJmg Atldress City Zip Phone <br /> SC?��t Q <br /> Apphcnnl Maihng Atldress Clly Lp Phone <br /> I � i <br /> Deacnbe Proposed Work il/P��/ � i )7� d.� /)G�N 0 _ <br /> I <br /> Pro�ect Adtlresslil known) �rL. � � — .�..fl�!/ ,�.'�. � <br /> i � <br /> Atfech lom(4)copies of plans lor proposad work� Draw Io scnle ana note ihe lollow�ng as epplicable�. � <br /> • Property Lines • Centerlme ol street � <br /> • Outline end�imensions ol all ezisting and • Indicete Norih <br /> proposeA structures on the lot • Show any proposed greding clianges <br /> • EMisimB end proposed utilllies • Show mensurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMITCONDITIONS <br /> 1.All calls lor inspectlon ehell be metle 24 hra.in edvanca-phone 259•8810. � <br /> 2.All work shell be peAormed In eccordance wllh thla permi�end current City ol Everetl Desipn and Const�uction <br /> . 9ten�erde end Specificatlons. <br /> 3.Call Locetion Undergraund Service 48 hrs,befo�e you dig.TOLL FREE NIIMBER 1•800�424•5555. � <br /> ._.�; <br /> O <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT Of CnNDITIONS <br /> ihc undersigned owner/applicant hereby apreea le hold and aeve horm� <br /> ----- less Ihe City ol Everett irom eny end all claims for tlamages, cosis, <br /> �h� /�GSf [3FN^�4r expenses. or causes of aclion thal may erlse becai�se of ins�alla�ion <br /> �����-`?I ��. /RD and mamlenance of Ihe Improvement o�other righl�ol-way use herelo <br /> �� �� apPGed for and lurlher agrees lo remove seme upon notice Lom Ihe <br /> Approved for ConmrucUon e�e Cily and to replace pubhc prope�ly damaped thereby. <br /> FINAL INSPECTION Date �--- `I � �1 S�9 <br /> �pprovedesConsiructetl SignaWr 1� ,.an�� Date <br /> everett PUBLIC WORKS UCPARTMENT WORK AUTHOR12ED BY THIS PERMIT MUST BE STARTED VATHIN <br /> � 3200CedarSireel t80 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everatt,WA98201 RE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone�259�BN10 I CANCELLED BV THE CITV UPON ANV STOPPAtiE OF WORK CN THIS <br /> � PROJECT OVER 90 DAVS DURnTION. <br />