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� <br /> r � <br /> DBt9 3 B S QOi .�«-�p,GGC//-u'..�'I PuUucWOMPom�l• �-� r�� <br /> Appllcatlon Foi eiao owi . <br /> PUBLIC WORKS PERMIT P�°;o„F;f� � � <br /> L�o�oo�ih n�b � <br /> Bmm.oo� • �C�• � <br /> Print or Type Onty <br /> l�, 1 (� ZSZ 5'0/ %�,..,.. <br /> T\v-� ���n�H'2� 17��jCar�TU�1F.c� �uc{p.� �.20Ti 2�� Z�n ""'�'- <br /> Owoer Melhng Atltlress Clty Zip p�pna � <br /> �-.w P.�-t���-, s�.....e. a.s �.Lo��. 4sz� � <br /> Appliclnl MailingAdG�es9 Cily Zip Phone <br /> Desc�IbeProposedWo�k _ �0.�Q �f�v � W0. �O�G �fl ✓G u�-'� <br /> w � �P i n �CL' O �OxS� Q�'1 ���dca.l0.r � <br /> a�t' �l7.2 � a�.�e, Di;�c �.�.a. 8a�lc o <br /> hcusc o-„ s ���1', — W <br /> Prolett Address(il known) � <br /> Attech lour�4)copies of plana lo�Droposed work• Drew to scele and note the lollowmg as apphcab�e: � <br /> � Prnperty Llnee • Cenler6ne ol slreat /w <br /> • Outlfne end tlimenaions ol ell exislinp end • Indicate North V, <br /> propoeetl sl�uclurea on tha lol • Show any proposed giading changes <br /> • Ex�ating and propoaed utliifiee • Show measuremenls � <br /> I DO NOT WRITE BELOW THIS LINE O <br /> I PERMITCONDITIONS <br /> 1. All ealla 1or inepectmn ahell be made 24 h�a in etivance• pnone 259•881 5. <br /> I2. All work ehell be pehormetl In atcordance wilh thi8 permil end currenl City of Evere�l Desipn and Cons�ruction � <br /> � Standards end Specilications <br /> � 3. Cell Locatlon UnAerpround Service 4B hrs. belore ynu dip.TOLL FREE NUMBER 1•800•424•5555. � <br /> I <br /> / O�<,�gs . �.c�. <br /> , /� � ,/{. �'c���"�' , <br /> : � � ` /�a�(�C�� ./ /4, �Ll� �/ • � <br /> ���✓ ( i o;.�L�' r• Q .:�� <br /> � ��. Cd 17� �'r�J' ��/S-L�u t✓�`� � <br /> !L�^"' , Su L�U,t� �� � �1`"`�/�C.'�^�-^y <br /> ��y� (� ,f� i7r�t+:E: r� l� O <br /> �'- o / �J `C,�Lti � <br /> � � �,ti�( � �� �' G. <br /> � ACKNOWI.EDGEMENT OF CONDITIOPIS <br /> r <br /> � The un4PiSlgned ownP.r/Apphpanl hMeby egreee�o hold ond save herm� <br /> loss Ihe Glly ol Everr.tt irom any r�ntl all clalma lo� tlnmages, costs, <br /> ezpenses, or ceuses ol acbon thet may arise becnuse of instelletion <br /> ;�i^ / t� /� and muinlenance ol Ihe improvemrmt or other nghbol�way use hareto <br /> / l-r✓ (�c`MT"`t+�� epplietl lor and furiher ngiees to remove same upon notice Irom the <br /> ApproveC Iqr Construclion �� Date � <br /> City nd to�eplace pubhc y demaped Ihereby. <br /> FINAL IN!iPECTION Date �����--- '� � 'J u J <br /> ApproveC. es Construcled Sign ture1M AppGc nl Data <br /> evcrtlt PUI3LIC WORKS DEPARiMl:NT WOR AUTHORIZE iHIS PERMIT MUST BE STARTED WITNIN <br /> 3200 Cedar Straet tB0 Cl4YS OF DATE PERMIT IS ISSUED ANO TNEFEAFiER IS TO <br /> Everett WA 98201 BE DII.IGENfIV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> .�. �... . . . CANCfLI Gf�PY TNF CITV llP(1V ANV CTn�PQ.E O�WORK(1N THIc J <br /> l_ <br />