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/ r � <br /> �8te� _ I.P�plie WorM�Perm�l• <br /> . AppliCatlon Fo� aiap o•ot• � <br /> •�-� PUBLIC WORKS PERi�;iT •� 7u0ueWerbFN <br /> , Tow r.. : <br /> /v Lw�ppl FN P�1a S <br /> Print or Type Only ��" a.i.M.o�. si 3� <br /> � 7�4- �°IB <br /> �n�v►�or� �N�. �Zii �� S-. Sw_ S�►�E �2 C�'NNWZbD �A .980aj(� <br /> owner MaiNnp ACtlresa c��y zic Phone -77�2,3op <br /> C'C�t►v�ECZ�iA<- D�SIC-vll ���A-i�C �23a (`1gTH S�- SW, LyNNWaa� R'8o,31t <br /> Applitant . Moilinp Addresa City Zlp Phone <br /> Deecrlbe Proposed Work � n� CC��I� <br /> Pro�eet Add�esa(il known) Z� G �✓0 G} G.�l I931� � <br /> Altech four(4)coplea ol plana for propoeed wark•Draw to acele and note the Iollowinp as eppllcable: � <br /> • Property Llnea • Cente�llne of etreet � <br /> • Outline end dimeneions ol ell exiating end • Ind�eate North <br /> propoeed et�ucturea on Ihe lot • Show any proposod gradinp chanqea <br /> • Exletinp end proposed utllltles • Show meanuremants � � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All ca11s lor inspaction ahell be made 24 hra In advenca•phone 259•681 5. � <br /> 2. All work ahall be perlormed In eccordence wlth this permll end current City of Everett Deaign and Conetruction <br /> Standerds end Specillcationa <br /> 3. Call Location Underground Service aB hrn.before you dlg.TOLL FqEE NUMBER 1•800•424•5555. � <br /> � ��- ��«-�,��s 0 <br /> H <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignetl owner/epplicant hereby egrees to hold ond save harm- <br /> less Ihe Cily ot Eve�ett irom any and all claims lor dameges, costs, <br /> expenses, or causes ol action Ihat may arlse because of inslallalion <br /> . � �/� „ and mamlenance ol the improvemenl or olhe�righbobwey use hereto <br /> Appr vetl I oi s r ion __ � applied lor and luriher agrees to romove seme upon nolice from tha <br /> Date City an lo replece publlc property tlamaged�hereby. <br /> / ` //_� ' o � <br /> FINAL INSPECTION Dale �+ � <br /> Approved es Constructetl S nalure ot Applicanl Da1a <br /> everelt PUBLIC WORKS DEPARTMENT O{iK AUTHORIZED 8 THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreel IBO DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLV PUFSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phonc� 259-i71315 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVEf7 90 DAYS DUF7ATION. <br />