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�8f0�K0 �•�,i i�� vvn,�-n,�,m��n�Y <br /> Application For A'"'; n`°� • -_`x-' -L�,—.- <br /> PUBLIC WORK'� �ERMIT �°„°°W°,�-��° ------ <br /> .o,..�.� :— - <br /> l�ea�ou� !r�.I nd S. — <br /> PriM rn Type Only �•�•�"'�" s - -- <br /> 7 / s�� -z�nl �..� 5��.�Lf1�=.�lle� <br /> 'wner —��' Alelling Address C�ty Zip Phone <br /> l��[�P�".k10i� (n�� l?9x/��,rf N Srb75��A.�.f}-�d'L.���ZS-z�� z <br /> 4pplicant MadingAtltliess C�Iy 2ip Phone <br /> Deetribe ProposeU Work �,�nw Y ,nn;llh11/J� � ,��y1_%�/�/,�k.l--�c.y�4-fy�f <br /> .�7-r�_ <br /> - --- W <br /> Prolect Address lif known� �l/Y /G �(�fiy�o Rs/ ___ . �, <br /> Attech lour 141 �opie9 0l plens lor propoaed work-Ursw to 6cele and rote the following as applicable�. � <br /> • ?�ope�ty Lines • Centerline of slreet � <br /> i Outline and d�moneions ol all ezisling and • Indicatr± North <br /> proposed Structures on ihe lot • Show eny proposed grpding r,hanges <br /> • Existing end o�opnsed ulllill�s • Show measuromenls � <br /> DO NOT WHITE BELOW THIS LINL <br /> PERMIT CO��DITION3 O <br /> 1.All cclla lor Inepectlon ehell be ineds 24 hrs.In advanr,e�phone 259•881 O. � <br /> 2.All work ehali be pedormed in ecwrdanco with Ihis parmit end cuvonf Clty of Everett Design and Construction <br /> Slenda�da end Specihcatlona. <br /> 3.Call Locatlon Underg�ound Servi�e 4B hrs.belore you dip.TOLL FPEE NUMBER 1•800•424•5555. � <br /> /I� /� � , � � <br /> G'� /�xC`; 2�'n� '��, ,`7 '��. - C.>,� <br /> i C <br /> � <br /> � <br /> O <br /> a <br /> ACKNUWL[DGEMENT OF CONDITIONS <br /> 1h��unde�signed owneunpPhcan�hereby agiees lo hold and save harm� <br /> - - -�--��I less Ihr. Gly ol F.v�relt Irom any and all clalms for damage5, cosis, <br /> Ie.n�nses. or cuuses ol action �hat mny anse beca��se ol inslalletion <br /> and mamtenance ol ihe improvemenl Jr o�he� !i�hbO6W0y u5E hPfC10 <br /> I appheA Inr and lurihe� a9recs lo removr. 58rne upon noti[e �rom ihe <br /> AOP�oved 1or Cnnslruction Date �;Iy anA to renlace pu6lic pioveiry dnmaged thereby <br /> FINAL INSPECTI(iN Dale <br /> ApProved as Conslruc�rd Siynature ol Annl�r.ant Dale <br /> everen PUPI.ICWORKSDEPARTMENT WORK AUTHORIZflD CiY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere�t,WA 98201 I BE DILIGENfLY PURSUFD TO COMPLFTION. THIS PERMIT MAY BE <br /> Phone.259-8810 GANC[LL[D�Y THE CITV UPON ANV STO 'PAGE JF WORK ON THIS <br /> IPROJ[Lt OV5R 90 UAYS DURf,TION <br />