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' R'^ � /I <br /> Date�`�J � 3 P,�ner wn,�a rr,mn. _/i(-�� -- <br /> � <br /> Application For A�ae oeo� • _ <br /> PUBLIC WORKS PERMIT °°°°°W°,k°�°° s --- <br /> tolel Pne <br /> Leff Apyl F!!P�i� s�_ <br /> Print orType Only BaienceDue <br /> S n '�'`—� <br /> l!% - ,'Y��-� ii/,9�/ <br /> Tff-E ��* r,�G Gn. , �a B�3"1a7 n�� �-?C SEir-n'c.c.� G✓�. g�il� �d� -��G7 <br /> Owner �r Mnihng Address Ci1y Lp Phone <br /> Applicant Mading Address City Zip Phone <br /> Oescribe Proposed Work DUT��' GA�P��X. P2a[,o,�,p r({'/VIP�/L/III�/ (fij�pS/Q� CD�/�d� <br /> _ — <br /> Prolecl Address lil known) �o�3 • GA�l•/n I[–/�, �i✓E2�� � <br /> � <br /> Atlach lour 141 copies ol plans toi proposed work� Draw lo scale and note�he following as apphcable � <br /> • Property Linas • Cr.nterGne ol sVeet � <br /> • Outline end di�ensions ol all exisling antl • Indicate North <br /> proposed struclkres on Iha lol • Show nny proposetl grading chnnges <br /> • EMisling an� proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for insoec�ion ahall be mede 2a hrs.in advance-phone 259•F3810. � <br /> 2.All work shall be perlormed in eccordence with ihis permit and current City of Everetl Deslgn end Constructlon <br /> Standerds end Specilica!lons. <br /> 3.Cell Location Underground Service 4B hrs.before you dig.TOIL FREE NUMBEH 1•800•424•5555. � <br /> �� / / � <br /> �[ �f'� 7L la. (�C���c f).i'� c7L�ing :i�)�).-/'!.'c�' �' � n <br /> / <br /> ;���/f; �y ��h? �[ '�� ic.f/ �,/(c � r[�r-Y'/-:_S� c.��,��. <br /> �['�l<' �. t�C�,�Y� � <br /> (1 � � � �� o <br /> OC1051993 a <br /> .................. .. <br /> CI1Y OF EVERE7T <br /> �ullding Dlvision <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The untlnrsl9ned owner/appGcanl hereby egrees to hold and save herm- <br /> — — ---- less the Gdy ol Everett Irom any end all claims for dameges, costs. <br /> eMpenses. or causes ot action ihat may a�ise because ol instelletion <br /> ' /� , /,._ and maintenanr.e ol ihe improvemenl or other righl�ol�wey use heie�o <br /> I - � ! i1 � ����';' . �-- ��y�i �pplred lor anA �urther agrees lo remove same upon notice Irom ihe <br /> App�oved f �slruc�lon� , 3�e C1 1 1 M I�A b replace public property damaged thereby. � <br /> � � `/ / ��'�.s�Z J� <br /> l / rJ—`�—�—�'(���' <br /> � � / �� � � i, <br /> FIN L I EGTIO'J ' .� / ' Date <br /> Approved as Con�druol@d/ Signature ol Applican� Dai.: <br /> � ?UBLIC WORKS DEPARTMENT WOFif: AUTHORIZED BV THIS PERMIT MUST BE STAFTED WITHIN <br /> 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> '�� 3200 Cedar Slreel BE D�LIGEiVTLV PURSUED TO COMPLETION THIS PERMIT MAY dE <br /> �j Everell,WA 98201 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WOi7N ON THIS <br /> Phone�.2G9�BA10 PROJECT JVER 90 UAYS UUR4TION. <br />