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� AVPIicalion For ,� � <br /> PUBLIC WORKS PERMIT De�e-_ �/i-5���� <br /> PUBLIC WORKS DEPAPTMENT Public Works Permlt M _�/p/�.95 <br /> 3200 Ceda�Street � --- <br /> Everett,WA 98201 259-0810 <br /> �8 2 9 �yy� Building Permit M <br /> TYPEORPRINTONLY Tn D�ISTING a�n„�wo�SF�a_�SOO o6 <br /> T� �-.N� eo. �s. a� 3�0-,�10��--�3 .�-� � �� 3s-�s <br /> Owner Mallin Address � City Lp Phone � <br /> ApPlicent Melling Address City 2iP Phone <br /> Describe Proposed Work __ �.7►R.�¢�LNc� / G�!'�✓ �-'02 Gfj�/ /'Grl/LtLu�/u6'N � <br /> _ CLrNT�i�- �iiSf�L� S�wt�3 �x7�r i�4 r. A�.rb <br /> � <br /> � <br /> PROJECT ADDRESS(if known) 3�.3 W, C/?�S�N t9 2� �D� ?�O'2.� � <br /> Atlaeh four(4)coplee ol plana lor pmposed work-Drew to scale end note the Iollowing II appliceble: � <br /> �Property Llnea �putline antl dlmanslons of ell ezistlnp end proposed siructuree on the lot �Existing antl proposed utllitles O <br /> �Centerllne ol etiaxt qndlcate North �Show eny proposed grading changes �Show measuremanis <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shell be made 24 houre in advance- phone 259•8810. <br /> 2.All work shall be pertormed In accordance with this permit and current Clty oF Everett Design and � <br /> Construction Standards and Speci�ications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-42�-b665. � <br /> /, GT�O�� � -�L OoriG ��" 2��/�ov'Co� �o�4i�t �II <br /> 0�4�to� S-�e7 .q� O <br /> a <br /> ACKNOWLED(3EMENT OF CONDITIONS <br /> The underslgned owner/applicant hereby agreas lo hold antl seva hermless <br /> � �,� ,T�O 9 the City ol Everatt fro;n eny and all cleims for damages,costs,erpenses,or <br /> Approved onsiructlon Cate causas of actlon thet mey ense because ol Installatlon end maintenenca ol <br /> ` � Ihe Improvement or other�1ght-of-wey use hereto epplied lor end tuAher agrees <br /> � _, �� ��/ `� to remove same upon noNce from the Clty end to replece publlc pmpedy <br /> demaQed ihereby. <br /> NPJ• � S Dale C/��_ . / . ������[+�s'�. ' <br /> Approved es Constructed <br /> SlEnatureolAp� S /�a�� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF DA7E PERMR IS ISSUED AND THEREAFfER IS TO BE DILIOENTLV PUPSUED TG <br /> COMPLETION.THIS PERMIT MAY HE CANCEI.IED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />