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_ R�i <br /> 1 <br /> � � <br /> Q�y _�9/ �/ -2�-z�-5 — -- <br /> � D8�0 r�ni,cwo,�.n.�mn. 9� 191 i <br /> �71 7�nrQh� I <br /> Applicn�iDn For A�'�p D^D� �_ � <br /> � PUBLIC WORKS PERMIT °°°°°w°.'.`°°� <br /> ,o�.�... •— <br /> ��� �...�oni r..v.�a S �. <br /> o.i.,,�,n�� 5 ��l <br /> R�� Print or Type Only _ <br /> ��� ��a ��, / ;���} �pU,31 -��,,,J �, Sf L- v-� 9�208 338-027/ <br /> ar Mailmg Addrnss Clly ZiU Phona <br /> �+6� /�� La� a�15�- 8���-27���+� PI 1111�) S-Innu�n� 9�292 �a59-g5�1� _ <br /> �� ppplicanl Meiling Address Cily Zip Phone <br /> � Descrlbe Proposed Work II/�J � �� I " 1 �� 5� <br /> �� � <br /> • ���� P�olec�Address lil known) Z-� �S G e- � <br /> Attach four(4)�oPies of plana for proposed work-Drew lo scele nnd note ihe lollowing ns appl�ceble�, � <br /> • Properly Llnes • Cenlerline ol slree� /A <br /> • Outline end dimeneions o�ell exisling end • Indicate North V� <br /> pmposed struclures on the lot • Show nny proposed y�ading changes � <br /> • Eaisling and proposed ulililies • Show mnnswemenls M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> ��- ���� PERMITCONDITIONS <br /> I 1.All calls lor Inspection ehell be mede 24 hrs.in ativence�phone 259•8810. � <br /> � C�� 2.All work shell ba peAormed in BCCordence wilh this permil end curren�City o�Evere��Design and Cons�ruc0on <br /> Stendarde end Specilicellons. <br /> 1 ; 3.Cell locelion Untlergrountl Servite 4B h�a bxlore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> � � O <br /> I � ' � <br /> O <br /> 1�1 a <br /> � ' 1�I ACKNOWLEDGGMEN70FCONDITIONS <br /> � � — The undersi9nr.d ownm/epphtanl hereUy Bgrees lo h01A and 5nve harm� <br /> �r' _ —� <br /> Iess inir City ol f:veret� Irom any nnd nll claims lor Aamapes, cosls <br /> � espnns�s. or causes ol nclion ihal mny anse hecausn ol Installxlion <br /> I _ � p � � � �_�7 �__�I .111A mainlennnco ol ihe improvement or niher ngM�o4wny use hereto <br /> � �:,�.�, � nppheA lor nnd lurther nyrees to remove same upon nolice Irom Ihr <br /> � ApProvxd lor ConstrqWiqti �a�e Cdy and lo replace pu6lic properly damagetl Ihereby. <br /> �/����� -- '� -� .�- '% J , � <br /> ' oa�a '� �� > >> .� /�-���� <br /> FINAL INSPECiION �� <br /> Approved ns Cons�rucled s�u�.�����P���nnni��a�,� ✓ D�te <br /> � PUBLIC WORKS DEPARTMENT WORM dl1THORIZED BV THIS PERMR MUST BF 57ARTED VJITHIN <br /> I80 DAVS OF DATF PERMITISISSUED AND THEREAFT[F IS TO <br /> 3200 Ceder Slreel �L UILIGENTLV PURSUED TO COMPLETION. TMIS �ERMIT MAV BE <br /> Everett.WA9P201 CANCELLED BV iHE CITV UPON ANV STOPPAGE OFYJORK ON THIS <br /> Phone�259-P[710 PqOJfCT OVLR 9G DAV: '.UHA710N <br /> I <br /> I <br /> I � <br />