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-r <br /> oate -' y _y� /OS � <br /> P�pec IYor��P�rmit• <br /> � Applicetlor� For Bino oeoi • <br /> PUBLIC WORKS PERMIT PU❑TolelieeF�' : -— <br /> La1s�ppl fee Pa�tl s <br /> f'� <br /> Print or Type Only B�ienceDue s �J ` <br /> D��z --.��zY�/783/ <br /> T/hs �3�����c Co. �'.v. �0 7 ,��S �aµ_�2. SE�I�.c� t,�� 9��� �c �-3JY� <br /> Owner Mailin Atldiess <br /> 9 C tY ZiP Phone <br /> Apphcant Meiling Atldress City 2ip Phone <br /> Des/c1ribe Proposed Work �%�-�/�'�� .SW/�-l�E !-�•h- /MP2Jf/�YJ (//tr}�.✓/O�G�" �'LO�vG <br /> _p/2 F''�KT �. •!�Np IrA3'�If P�-!� /Nrci'2S�rcr�o�/ A-PPwxin�,o�r.r- <br /> L6N cTN� fv�70 Ge�rr• — <br /> Proiect Add�ess lil knownl '��Ud-� � �.�� �QS r��V n p� � <br /> Allach low�4)copies ol plans lor proposed work� Draw to scale and note ihe�oliowmg ss appllcable�. � <br /> • Property Lines • Centerllne ol street � <br /> • Outline and dimensions ol ell ezisting and i Intliwte Nmth <br /> proposed slruclures on Iha lot • Show any p�oposed grading chan�es <br /> • Exisling and proposed utili�ies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PER1•I IT CONG'TIONS O <br /> 1.�C calls lo•ins?ection ehall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peMormed In eccordence with Ihls permit and current City of Everett Design and Construr�lon <br /> Standerds and Specificatlons. <br /> 3.Call Locatlon Underground Sarvice 48 hre.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> 7, �Ja 4�71`'at/�r..!-^ o�?ttcw-�y ,�J�p,Lc�v�..Q -�/���j! � <br /> (/ <br /> � <br /> f1 �� � ML� � V� <br /> l J MAP, 0 91994 O <br /> _ . _ .... .. . <br /> a <br /> CIfV OF EVEREIT <br /> �uildin� Divis�nn <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ __ ___ The unders�gned owner/Bpplicanl herr.by agrees to holtl and save harm� <br /> — less Ihe Gty et Everetl Irom any and all clalms for damages. costs <br /> / expenses, ur ceuses o� aclion ihat mny arise because ol installation <br /> j� 7L � and malntenance ol Ihe imp�o�ement or other right�ol�way use hereto <br /> epP��ed for and lurther agrees lo ramove eame upon notice Irom �he <br /> Approved lo� , Iruction / ate Clty and lo replace pubhc property damaged thereby. <br /> �� . `,7�—�` �e�� � � � . ��+..��{ • 3,�y�9✓ <br /> FINAL INSPECTION -'�'^(/E�� � <2�"!"�-�� <br /> Approved ns Cons�ructed Signature ol Appht� Date <br /> PUBLII;'.VnRKSDEPARTMENT �'�'ORK AUTNORI2ED BY THIS PERMIT MUSi BE STARTED WITHIN <br /> 32UOCeAerSiree� 1B0 DAYS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br /> Everel�,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV 8[ <br /> Phone:259�8810 CANCELLED BV TH[CITV UPON ANY ST(1PPAGE OF WORK ON THIS <br /> PROJFCT OVER 90 DAYS DURATION. <br />