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Date���_ �,e��,�w�,..no,m��. <br /> � ' % l. a � <br /> �f J-- <br /> App�italion FOr � oiav oeo� • - <br /> PUBLIC WORK.S PERMIT °°°°°W°,`.`°° : ----- <br /> Totnl ine <br /> Lna�00� feePud S <br /> Beience Due <br /> s �Y 70 "� <br /> Print or Type Only <br /> l f�f� �`n(t 1����� � (1 � j'' 0 j (ih ,3 �(�/' ��/� (���—/�. Sl`�j�-� r��, y�i�.r l�lF_�r � <br /> � Owner Mailing Address { Cdy Zip � Phone <br /> Appliwnt MailinG Address Gty Z�p Phone <br /> oes���naProPosedWo�k r�G �C��7-FP /'L_ (���� lv�7L�/:_ /��,4�/�J /;vT�� j"//E' �Vn�T/f- - <br /> /�l 9Ni l o�P• <br /> W <br /> PioleclAddresslilknownl j!l�.f - (�t/. CqSiI)!' l�C/. _ _ _ � <br /> AUech lour(4)copies M plens for proposed work� Draw to scale and note the lollowing as apphcable. � <br /> � P�operty Lines • Centerline of slreet � <br /> • Ou�line and dimensions ol all existing and • Indicate Norih <br /> proposetl struc�ures on Ihe lot • Show any pioposed arnding changes <br /> • Ezisting and proposed u�ili�ies • Show ninasuremrnts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cells lor inspection shell be mede 24 hrs.in advance�phone 259•8810. � <br /> 2.All work shell be perlormed in eccordence with this permit and current Cily ol Everett Design and Construclion <br /> Stenderds end Speci�icatlons. <br /> 3.Cell Location Underground Service 4B hrs.before you dlg.TOLL FREE NUMBER 1•800•424•5555. � <br /> y /�l( CC/CY'�4���/�r.c�c_'r'in,Ls /rit-Jt C r,r�f c: •n fn C.,tY nF O <br /> E c'CI'Y'�/ ✓�fa i,�i.� J�s O� B'l�i�'r r <br /> .J L,:%l�.,f �u ��.' cicnu• cu S�i.��J,� p„ (�Ca �� � V v � D � <br /> r,�,., .� !,y �h� �;!y �f Ev.�,. >y i z --� -s 3 � D � <br /> L � DEC 0 8 1993 O <br /> . . . .... .. . ... a <br /> CITV OF EVERETT <br /> Oullding Divis�on <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ihe undersi9ned owner/epphcant heroby ag�ees lo hold and sava lxrm- <br /> - � -------- less Ihe City ol Everett from any end all claims lor damages, rosts. <br /> // expenses. or ceuses ot �r.tion ihat mey arise because ul i�sl&Ilation <br /> ,��("� '/��� /��j�)� and main�enanr,e ol �he improvemen� or other righl�oi�way use nere�o <br /> �� apphed for and lurlher agrees �o remove same upon noti:e Irom the <br /> Approved lo nstruc�io ��1e Gty. �A to replace pubhc property damxged Ihereby. <br /> � . � ' /� � � -c�-.-..� ..� . 1.�.,..,i1��' i7/3/y3 <br /> FINAL INSPECTfON . � 1e Dale <br /> Approved as Conetructed Signature ol App ant <br /> � PUBLIC WORKSDEPARTMENi WORK AUTHORIZE� BY THIS PERMIT MUST BE S`ARTED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEF �5 TO <br /> 32�0 Cedar Street BE DILIGENTLV PURSUED TO COMPIETION. THIS PERMIT MAV BE <br /> Everatt.WA 98201 CANGELLED BY THE CITV UPON ANV�TOPPAGF OF WOFK ON THIS <br /> Phone.259-8810 . PROJECT OVER 90 DAYS DURAiION. <br />