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��� <br /> ��� g7-in.;- <br /> � c7 Date 4_("�7 �,.���,�w�.�.�,�m��. �p� <br /> �O�O AOPlication For Fl�nu oflnl •-�` ,r,�_*_-_._�.__ <br /> M �il -_-_ <br /> ��' PUBLIC WORKS PERMIT '°°'""'°,"`°° <br /> � ,o�.��e� s— <br /> O � ire+>rni ver cmn S <br /> �~ c�. �-� f o.,�.,,�.u�:,_ S_�'�— <br /> � �g Print or Type Onry TO P4S�1 NG-�. / � Z <br /> c�. c� <br /> �� H� ,�� � ���: � (.�) �,�Nri���nc c�. �/RD z 7 ��l; �,�l6 7 <br /> I���I /�i.m,� 3 - �- .. � ]'�'"l „— <br /> M H Ow r M.iJirg� la ts9 CitY 2ip Phone <br /> N <br /> �H _---_ _ _— <br /> f� y VQ rll 'P <br /> qpplicanl Mailing Address C��y Zip Phonc <br /> O� ���� �,j� p��� /'���� <br /> Dcaciibe Proposed Work / � / �a"-"'`-�--�"""""'T,r'r� —_ <br /> Ln�l Ci/A�iiiiCiiil( / ���' '�� _ <br /> -- W <br /> Prole�,�Atldres[PI knOwn) _Ll �O E Cf�S/'U� '��n. ----- � <br /> Altach tour 14)copies ol plens lor proposeU work�Oraw to scaie and note the lollowing ns applicable�. � <br /> • ProOerry Llnes • CeNedine ot slreel ♦A <br /> • Uutline end dimenslons ol al�aaistin0 nnd • Intlicete North V� <br /> prOposetl slruclures on Ihe lot • Show any proposetl gradiny chang�s <br /> • Existing and proposed ulili�ie� • Show measuremenls M <br /> l � ' DO NOT K'RITE BELOW iHIS LINF O <br /> ' ��I PERMITCONDI710NS <br /> 1 � 1. All calls lor inspection shall he niatl! 24 I,rc h ndtienca� phonn 259•Ba�5 w <br /> l � 2. All work shell be perlorm�id in xccorAai�a�with Ihis pe�mil end currenl City ol Fvurett Des��n end Co�:lruction ♦ <br /> , (�� Standards nntl Specilicnhons. <br /> ` 3. Cell Location Undergrou.id Sercice 48 hrs.beforEi you A�y.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> L�j�j.'L iC9..��T i:S' T� �i'["!-a.lJ[" _ fe--.i't�-� v�l.,;�.c. �c F O <br /> I ,~_ 7 �/17i�i. '�"'L!�-�Jlfr /�S j['i.: .'.,�/.-:'Y'T- i '�. i.'? <br /> V�� �!_�i9/.��9i1./i y F!"'' <br /> i ���ET TO h'f� l���i,:�.. ��.;i /� <br /> l.1�� � <br /> 0 <br /> � �-- a <br /> _� <br /> ' �� ACKNOWLEDGEMENT OF COND'TiONS <br /> I �1 � —'— — _ _ _ _ _ The undersi�ned owner/opplicanl hereby agrees to hcld and save h:um- <br /> � iess the City ol Everetl Imm a�y nnA all clalrt's �or dnmages, costs. <br /> \ <br /> expences. or cousea ol xchon tha� may arise hrcause ol installnlion <br /> ���'�� ,[� ^ /)`� �,/�G /�/- nnd mamtenance of Ihe iriprovement or olher nyht�ol�way use herMr, <br /> CJ7C" / � y npphed lor nnA lurlher ayrees la romove snme uGon nolice Irom Ihe <br /> Approved loi Construction� / ��fl�e City nnA to�eplaee publ�.:prop��rtY dTmayctl�hereby. <br /> �i <br /> "� ' � r ��•, '' � i ] I <br /> FlNAL INSPECTI N-�- � -- �Date ":1r,.. �.�n.`-`l. � ) ( � I :t 1 :� ,� �/ � � `�` <br /> Approved as C�nslru��ed Si9nnmr ol Applicxnl Dnlr <br /> WORK AUIHORI2E[7 BV 1NIS PERMIT MUST BE STARTED WITI�IN <br /> rvrrell PUBLIC WORK3 DEPARTMENi 1p0 DAYS O� DATE PERMI'� IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cednr Streel Ci[ DIUGENTLY PlIRSU[D TJ COMPI[TION. THIS P[RMIT MAV BF <br /> Evere�L WA 9d20�. (;ANCELLED faV 1HE CITV UaC N AN� STOPPAGG OF WORK(7N THIS <br /> Phon¢ 259-PB15 I'(i(1JfCTOVff�'�( D�1'SOU1:411�'r <br />