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� <br /> I <br /> Date�� � ��,�,�., �,,,..�.,m�. --- <br /> APPlicatian For N�no o� � ._��_�j)��_ <br /> PUBLiC WORKS PERMIT ru�Tol�iee���s - <br /> �����[o� FeePua 5 <br /> Print or Type Only eei����o�s f <br /> ��—��p�c ? ��� ���1� Q� iz � 3�Z—a�P�i <br /> Owner Meiling Ad— drosT— Cdy Zip Phon� <br /> 1 J <br /> �(''_ �_�+��- �a� l'ac � �/ic� �1A�Arc(�i� <br /> Iqppl"'� Icen� Mailin47 Adtlress City Zip Phone <br /> Describe Proposed�NorV.=�qJ._� - ---�9,�G�� <br /> i <br /> -- � _ ------�_ - W <br />� Prolect AAdress�il 4nownl �YJLyL-1G.L.S(�(eut�1U�----LLl`��.— � <br /> Altach low(4)copies of plens br propnsed��ork- Draw to scnle n!id note the lollowmg os apFlicnble: � <br /> • Property Lines • Cenkrhne of strecl � <br /> • Outline and dimensione ol ell ezisting and • Indicale North <br />, proposed structures on the lot • Show eny pmposed grading cnanges <br /> � Eristing end proposed utlutie� • Show measuremenls � <br /> I <br />'. DO NOl WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.Ail calls lor Inepection ehell be mad4 24 hra.in ntivanca�phona 259•8810. � <br /> 2.All work shell be pndormed In accordence with Ihis po�mlt end current City ol Everett Dnsign end Consiructian <br /> StandaMs end Spnr,ilicetlona. <br /> 3.Cell Locatlon Underground Service�4P�hyrs�.belore you dlg.TOLL FREE NUMBEH 1-800�42$•55bb. <br /> Pl��Lc/�Oi�� �JP/�wr.�,l ^V� .eP.�fX�Lv ��.t-a/� �'l/-8B � <br /> D O <br /> o�� 797�' �l/A-IPr 0�1y <br /> 79 6vl� � � �iz1a� � _ ��,� ��r��as <br /> ��/� <br /> � 2� 7f'7�g Cu6�zd �// <br /> � O <br /> a <br /> ACKNOWLEDGEMENT O�CONDITIONS <br /> The untlersigned owner/npplicant hereby ag�ees lo hold and save harm- <br /> less the Ciry ol Eveiett Irom any and all claims for dnmages. cosis. <br />. e.penses, or causes ol aclion thal may anse because of inslalla�io� <br /> and mamtenante o� Ihe improvement Or othe� nghPol�way u5e herelo <br /> epphed �or nnd Iw�hei agrees to remove Snme upon nolite from Ihe <br /> Appwved tor Construction Dele Gly and to replac� puhhc property dame9ed Ihereby <br />� FINAL INSPECTION Dale <br />�, ApproveA es CensiructaA Signalure ol AppliCanl Dale <br /> WORK AUTIIORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBUCWORKSDEPARTMENT �;,� DAVS OF DATF. PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIG[NTLY PURSUED TO COMPLETIUN THIS PERMIT MAY BE <br /> Evore�t.WA 98201 CANCELLEO BV THE CITV UPON PNV STOi'PAGE OF WORK ON THIS <br /> Phone.259�0910 PROJECT OVER 90 DAVS DURATION <br />