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. .y2�.7-�:o f:�':..��Ij f��y�`f:;�i,�+�'•I�,,,�T�'... .�R'2'�+�'rv`�:r:7�,� . -r .__ �'_ r� �..`. ' <br /> �.. . . S': •n•A� <br /> �8t8'���� ��� '��� / Pu�ucWod�Permu• (� <br /> B��p Dep1 • Q �� <br /> Appllcetion For �� <br /> PUBLfC WORKS PERMIT PublicWorM�fas <br /> Tolel fea S_ <br /> La�e�pD�Fee P�iO �_ <br /> B�hnu Dua s <br /> Print or Type Only <br /> GRAh�a� lNG. Pe &�X �Z2o LYNN�� �� vso3� �� ¢-oo q8 <br /> Owner Malling Atltlress Clly Zip Phone <br /> c�m�C�A� D�s�6ill �4��5_ 4'L� l9Br�i sl' skl GYNNkicnD w�4 <br /> Applicant Meiling Address City Zip Phone 77/.Z�b <br /> Describe Propoaed Work _— — <br /> I NE2� C.FRP��� /iiA1,� � �AI/�1f , ETG �T /N E>c ► STiwv <br /> I�IL�IN(o �_F�,T vi sro� . <br /> q �p cD,. W <br /> Pro�ect AddieBs Iif known) � 1 �s�� �`D- ���"t �, � <br /> Attach lour(4) coples ol plens lo�prol�Osed work•Draw to acele and note the loltowing as epplicable: � <br /> • Property Linea • Centerlina ol street � <br /> • Outline end dlmonsions cl ell e■Isting end � Indicate Nor�h <br /> p�opoaed atructures on th�lOt • Show any proposed gradinB changes <br /> • Exiating end proposed utliitfes • ShoN�measuremente � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection ah,�ll be made 24 hrs. in advence-phone 259•8815. � <br /> 2. All work ahell be perlorme•d in eccoidanco with this permil antl current City ol Everelt Uesign and Construction <br /> Standards end Specilicelions. <br /> 3. Call Locatlon Unde�ground Service 48 hrs. befo�e you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /UD I�U�L/C LCJ�!'.FS /���/�;yj ���c�✓C//.� F1� O <br /> I c�(!`� ,j/�s/86 `.. <br /> ,I "r'"" N <br /> I � <br /> � a <br /> � <br /> � ACKNOWLEDGEMENT OF C�)NDITIO��S <br /> The undersigned owneqnpplicant hereby agrees Io huld and save ha�m- <br /> � less Ihe City ol Everett Irom any and ell c�aims lor Aamagr.s, costs. <br /> expenses, or ceuses ol nction ihat may erise br.cause ol installalion <br /> ! end meintenEnce of ihe improvement or o�her nghPo4way ���r hereto <br /> opplied lor end luriher agrees lo remove samo upon nut�::c irom Ihc <br /> ApUroved lor Conslructlon Dale City nnd to replpce pu6lic p�ope�ty damaged Ihereby. <br /> FINAL INSPECTION Date . <br /> Approved es Conalrucfed Signa!ure ol Applicent Da1e <br /> everett PUBLIC WORKS DEPARTMENT WORh AUTHOFlIZED BY TFIIS PEHMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CeAar Siree� BE DI�IGENTIV PURSUED 'O COMPLETION. THIS PERMIT MAY BE <br /> , Everelt.WA 98201 CANCELLED BV TNE CITV UPON AhY STOPPAGE OF WORK ON THIS <br /> Phone� 259�8815 PFtOJECT OVER 90 DAYS DURATION. <br />