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Date�9 �,7 , �7- 2Z� <br /> Pu���c WarM�Perm�l� <br /> Appiicotion For eieo oev� • <br /> PUBLIC WORKS PERMIT PueToteFeeFee s <br /> LeesApo� Fee Pai� s��---- <br /> Babncn Due 5 �D <br /> Print or Type Only <br /> � <br /> o�PAqI•rF �A2�'u..s �.�.,i �:'d.�iF ,�aE��77- '��n� �?S.'z. �Sad- <br /> Owner Mailing Add�ess Clly ' Zlp Phone <br /> ! i2 �l� �BH�Nk.ow 1 2 $V) <<���' � ,�U�'11.-'£"�l �.S3o/ ,�Sa- ,�'°_a— <br /> Appllcent Mailing Address City Lp r'hone <br /> 1.cv.s1Q -+;+� F��nc& ar, C � /���'�� <br /> Dascribe Proposed Wo�k — <br /> RtiD 7A15T1�GL S/oEr✓4 Ck �IEXT To Cu.zB <br /> Aconl� cA�if'a�eni,A . — <br /> �� W <br /> Project Addreas(if known) SQ M E i�S J� l�a��� oy.�y • � <br /> Attach lour(4)copies ol plene loi proposed work- Oraw lo acele nnd note the lollowing appliceble: � <br /> • Prope�ty Linos • Cenlerline ol atreet � <br /> • Outline end dimenslone ol ell existing and • Indicate North <br /> p�oposed structures on the lot • Show any proposad giading changes <br /> � Exlatinp end proposad utilllies • Show mee�urements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calle lo�Inepactlon ehall be mede 24 hrs. in advence-phone 259•8$1 5. � <br /> 2. All work shall be perfo�med in accordenco with this permlt and current Clty of Everett Design and ConsVuctlon <br /> Stende�da end Specificatlons. <br /> 3. Cell Location Unde�ground Service 48 hrs.befo�e you dig.TOLI.FREE NUMBER 1•SOO•424•5555. � <br /> y AI�PGiCANT 7a /�'�nVE FEN�E /F GUA7E'2 ,tjE'PT. O <br /> /IJEEDs To GJO,eK A� C�FITE,[.' f/!lc�iE U.c h'lA��✓, <br /> S I•USTl�(.L S�DFCJ9Ct /��R C�T�/ S�F•v/)H.PU �6' 3�7(0 . (S��Ti/CK. � <br /> �,. r'c�v� To I�F l�o�✓E �z �T'9C,YFo S.�ETC'�/. � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS ( � <br /> The undersigned owne�/appltCAM'11b1eby�agr�8��l�a}�fl}�titYeY+ve t��rm�- <br /> less the City of Eveiatt Irom any dnd all clalms lor demages, costa, <br /> c � ezpenses, or ceuses ol eclidtl�iAAt''nRN arise beceuse ol installation <br /> end mainlenance o� ihe impruVbment o� atHd[:AahPof�wey usa heretn <br /> epplied lor and lurlher aBre9s t4;cemove..agmry.NPo� �otice Irom Ihe <br /> App�ovetl for Cons f n Da�e y City end to replece public prop^rti�y�dnmegobyhgieby. <br /> l�l/ �-�f �/ _ <br /> FINALINSPECTION Dete � ���J� ��'-�" �'-'�L-��u4'' --� <br /> Approved os Constructed S g nldia ol Applican� � Da�e <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT IAUST BE SIARTED WITHIN <br /> everett iB0 DAVS OF DATE PFRMIT IS ISSUED nn0 1NEREAFTEP IS TO <br /> � 3200 Ceda�Slrael BE DILIGENTLV PURSUED TO COMPLETION. THIS PLRMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WOfiK pN THIS <br /> Phone: 259-BB15 PROJECT OVER 90 DAYS DURATION. <br />