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�; <br /> � <br /> r � <br /> / � . . . v�ne�won.r.,��n. �' Z <br /> DBtBSe"/�[��T eieu o.o�.• -- <br /> Applicatlon Fn� / . � <br /> WORKS PERMIT 1 rveecwon.ln e 74�7 <br /> PUBLIC ����- fo1�IF�� <br /> ��/ u..eooi r..c.�a ���f—Q�' —�— <br /> �O B���ncs ou� �� <br /> Print or Type Only <br /> + n �ieS�Nt � o � L4I<P l�fl'rvlAfD� D��IlVN� Pnone <br /> D �fef � Mellinp Addresa CItY ZIp <br /> SA'M E. - CiIY 2ip Phune <br /> Applicent Melling Addresa <br /> � 1 .(/1 <br /> Oeecrlbe CroFoeed Wo�k <br /> C b " T f ' I �O I/� �,� �� �N I ` � I b r u l�l� L � I I N - _ - <br /> �� <br /> - W <br /> Pro)ecl Addreee(if known) <br /> 1 H- <br /> ��� <br /> Atfech fow(4)coplae ot Plans tor propoead work- Drew to ecale end note the following es enPlicable�. � <br /> • Property Linae • Cente�line ol street <br /> • Indicate Noilh <br /> • Outline end dlmenelona ol ell exietinp and � ghow eny proCosed greding changea <br /> propo.eA etruclurne on t�e lol � ghow meesuremenls M <br /> � Exfellnp end propoeed�tllllle6 W <br /> 00 NOT WRITE BELnW?MIS LINE O <br /> PERMIT CONDITION8 � <br /> t. All ca116 for IneDectlon ehell be mede 2a hra.in advence� phone 259•887 5. <br /> 2. All work ahall ba perforroed in accmdance wilh this permil end cunent City o! Everetl Design and Consiructian <br /> Stendarde and SDacillcatione. � <br /> 3. Cal�Locelion Underground Servlce 4/8 hrs. belo/re you diB.TOLL FREE NUMBER 7•800•424•5555. <br /> � G�''� "/'/r'`n-..Q d ��1.�J5 O <br /> � -�p / C/�yj/'�/r t�z1 ¢ !�'/'G �l ���f CA7L�' . �"' <br /> / / J � � <br /> � <br /> �. <br /> ACKNOWLEDGEMENT OF CONDI110NS <br /> The undersigned owneUepp�icanl hereby eBrees to hold end save hnim- <br /> �—r less the Cily of Cveretl liom nny and all cleims lor Oamages, coats. <br /> � eapenses, or ceuses ol ac��on Ih3t may arise because o� inetelletion <br /> and maintenence ol the imprcvement or other nght�o4wey usr hAredo <br /> apnlied for end further egrees lo remove seme upon nolir.e I�om the, � <br /> Ap ove ns ctlon �B City and lo rapiece puhlic pr perty damegetl Ihereby. <br /> IZ I Da 4�"� h "`� e,e" <br /> FINAL INSP CTION Si gnatura oi Appllcan <br /> Approved es ConsVucted <br /> WORK AUTHORIZE V THIS PERMIT MUST BE S T A R T E D W I T N I <br /> everett PUBUC WOH ., EPARTMENT 18U DAYS OF DAl< PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGEN'LV PUi75UED TO COMPLETION THIS P[RMIT MAV BE J <br /> Everalt.WA 98201 CANCELLED EV TN[ �ITV UPON ANV S?OPPAGE OF WORK nN TIIIS <br /> Phone: 259-8815 PROJGCT OVER 50 DAVS DURAiION. <br /> :_ <br />