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/ "� Pu�Lc Wo�4�Pe�mi�� J � �'J � <br /> Oate1�j Bi�9 Oeo� � _ __ <br /> Appllcation For <br /> PUBLIC WORKS PERMIT P�OIivWa�h�iee s <br /> Totnl Fee <br /> Lxs��ODI Poe PaN s <br /> Balance Due s�C n� <br /> Print or Type Only �//O��" 3 �nL-jllY�/y9�/ <br /> �On� .� oOd-.J�SfT�/Z93/ <br /> 7'N-6 1�����1��r� ('o P. n, <'�oJC 37n) M/s O� 7�, Sf�71"�F:, Gu/.� � 9�/�� <br /> Owner <br /> eJing Address Cdy � Zi� Phone <br /> j!�-Yl�l�' �J 7�'i'�� /�/ Zip Phone <br /> Applicant <br /> Mailinp Address Cdy <br /> / „ < �/f C'.G /�`-O�4� <br /> CCJnJ ST/' V C T 7.C� W 1�� f'�'rV�=17 .��;�'�— <br /> Describo Proposed Work � <br /> 20/'� y(� `�/ I'c J� 7"�� 7NE A-cT�t�;7� c �n�i c �.,• <br /> - W <br /> 3on3- c�i, C ' -P 5�0- y B :�dr' � �, <br /> Projact Address lii knownl — <br /> Atlech lour(4)copies of plans�or proposad work� Draw to scale and note the following as apUlicable: � <br /> • P�operty Linas • Centerline ol s�ree� <br /> • Indicale North <br /> • Outline and dimensions of all exisling and � Show any p�oposed greding chenges <br /> proposed structures on the lot � ghow mexsurements M � <br /> • Exlsting and proposod utililies W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEHMIT CONDITIONS � <br /> 1.All cells lor inspectfon shafl be mede 24 hrs.in advance-phone 258•8810. <br /> 2.All wor::shell be peAormed in accordance with this permit end current City of Everett Design and Conslruction <br /> Standerds end Specilicatlons. � <br /> 3.Gail Localion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800�424555 . <br /> y ��C�4i"yn� li.,,,ts fo /x /� o� e�cG si�� af' CP��fa�-- ���� • O <br /> S O�"�t,oiG TSUils fa �c' ��ovc>�/ onLe «•��/ S�o�-rav 4.�t;unc/ <br /> �'it'�i�iJ4 /�CCS /n LC'�c.� 4/�C'�S' O[�J/�P Of C��2ni•in� L/ini� • � <br /> ✓ <br /> � Jnsfa LL Silf �en�e oln.� �Se /�tr�h-easf' Qre� trf' �'o��sfi�at�on � <br /> 4s direcf��c� 6y f/,e pn6l:a i��n��s in�a:t�o�. <br /> fhC rn� �nf•le �s �c$u��eO� O <br /> � c����,-t 4,>y �ow �����-s ;,� P � <br /> � ['il�n/e�,4i� �nh�ii� 0�7 �/�C lUBSf Si�C Of /-Ga�ci.e�� r.rhw�/r <br /> 7s. A�n.0 d.lt/�..,� �✓ crr�e•- O°s�:6/e S/He%{!.w✓ r.in/cr o l�rn n/.ity f1o�,,;.,�»,:K c w[ <br /> y- <br /> �/y�intezc% n�,f/ ¢�nScc/ aa.-f/ Q�t��.- coi..r�"[�!-7/D/J . YUnOfY�• <br /> y �.rnTErTSe,.e�.�y mwRtty.e � e.-`'vl�ND�'��.e��//•%y.3 By !be <br /> �n �,Qd ���������,n fn 6/C �S /� � ACKNOWLEDGEMENTOFCONDITIONS <br /> �,<.�.�5'pu6l,< <`��'��f Q e� The undersigned owner/appliwnl hereby agrees to hold and save harm� <br /> less the Cily ot Everetl Irom any and all claims for damages, costs. <br /> � e.penses. or causes of action thal may etise because ol installation <br /> ` � and maintenance of the improvement or olher right�oFway use here�o <br /> 3 applieA for and furlher agrees �o remove same upon nolice Irom the <br /> qpprove 1 nsl �pn Date qtp n r lace pubhc properly damaged thereby. <br /> � / � "�_�� l� �/• ! _'=`�wvf;` ' A/7��� <br /> NAL I SPECTIO � � � �e Dale <br /> NOV O 1 lure ot ApPlicant <br /> Approved as Constructed WORI< AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT , �pO..�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSlreet '�� V �ei�.'�GENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evcrett.WA 98201 CITY OF `��FLLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> U�r <br /> Phcne:259�BB10 BUIId1I1Q bJECT OVER 90 DAYS DURATI . <br />