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Date /2// 9/ c„ni�cwoa•p„�mn• � U�� / <br /> Application Fm nioa oe��.. <br /> PUBLIC WORKS PERMIT r�mmWoa�fea <br /> Tolai iee S <br /> Lea��oG� FeePaitl S <br /> Print or Type Only d•�,�«o�e s (• <j0 �u <br /> 'j N� (ja�in�6 C� � � �� o. � °x 3�v7 ��5 n�=-7� S�nrrtc �,��,9YZ/ jY2S"�7� <br /> Owner Mail�ng Addross City Zip ' Phone <br /> G�E � oWN�, 2 <br /> Applicant Mailing Adtlress City 2ip Phone <br /> Describe Proposed Work f'`m�+�.�'f� `r'n.r-���+�.. ��z�1t�� �L�.4' �c'��d.f o'� T'�5.., <br /> �iJst ZT✓ C�7�s,.T`tem- _f'a-,..1?`.c. �r �ifc� �lJ-�S�' ii� .%�" q -� <br /> J!i'.fin�; <br /> i <br /> Prolecl Address I��known) `�n�J� k% �r3/�i � � � �� <br /> Altach four(4)copies ol plans lor pioposed work-Draw to scale and note the lollowing as applicable: JA r� � 9 1992 — <br /> • Proper�y Lines • Centerlino of streel " � <br /> • Oulline and dimansions ol ell existing and • Indicate Norih <br /> propoaed strucluras on the lol • Show any proposed qradiny c�i�dCgsOF EVERETT <br /> • Existlnp and proposed utllitles • Show measwemenls C �l' � <br /> Bufld <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells lor Inspection shall be made 24 hrs.in advence-phone 259•8810. � <br /> 2.All work shell be pertormed in acco�dance with this permit and current City ol Everett Design and ConstrucUon <br /> Standards end Specillcations. <br /> 3.Call Location Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•8 ��• n rl � D � <br /> v <br /> �! L�� ,� � d�� �� ���..ti ��.�.�,.�,�o �nrt „ s Q <br /> �C��C.d Lvt�z�u.� on- / 7s— y.� , <br /> ° 1992 <br /> ................................... � <br /> �_� �/ C CITY OF� E'JEFlG'f7 <br /> S �v'�'' 'u' �"��`� v+o�cc/+-.7� �r.T�+Z~u-f� �L��� Bul!din� Dlvi;lcn /A <br /> �'�.��.t�- -/{Qt�c.�i.�t/ Q-i�cl� G.JJl�C.cl[���_ ��fJ✓L�/f � � ��� <br /> � U r <br /> � .Q�pan.�L�. �Y��7c>vecl��j' �+�i� �Cch,cr<(':t�cec:.. ct,�..c!' <br /> 11���� ,c�2�.� �ti F:s. :�� ���'/��.,.,.�;. a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl horeby agrees to hold and save harm� <br /> B less �he Cily ol Everel� Irom any and all claims for damages, costs. <br /> oxpensns, or cuuses of action Ihal may arise beceuse of installation <br /> Y�� ���r and mamtenance of ihe improvement or other righPobway uso hereto <br /> applied foi and furlher agrees �o remove same upon notice Irom ihe <br /> Ap v� r ons ion Da e City and to replaco public property damaged Ihoreby. <br /> � / <br /> / � <br /> >� 3 , /-�.��-� i�z9�9� <br /> N IN E TI N �� Date <br /> Approved as Constructed Signatu ol Applican� Date <br /> � PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIih11N <br /> 3200CederStreel 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everalt,WA982(It BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WOFK ON Th11S <br /> PflOJECT OVER 90 DAYS DURATION. <br />