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� <br /> l� <br /> 1 <br /> � � � <br /> � y /,, /n '�` � Pueuc WONs Prmn. <br /> �o c Date�l�lJV �I��fS7� -- <br /> � eiao��w• <br /> �C "3 y qpDiir:ation FO� <br /> � � PUBLIC WORKS PERMIT �JUtoaifecrre s <br /> O C O lsss Rp01 fCa Vei� S <br /> `0 M �y <br /> y M Baisnce0ue S <br /> � � � Prinl or Type Onty <br /> � ;° � �d�b / � C t/P/P� �/�2D 07.5��Qd6 <br /> y H � Mailmg Address �dy ZiP Ph°°e <br /> S �n Owner <br /> r M H � <br /> y <br /> O m Mainng Atldress Gny Z�p Phone <br /> C ^ pPlicant , <br /> � � t9 / / }� <br /> y y ►�,�. L /An * �q�j�l� �+--�--1 <br /> � y Describe Proposed Work �-�-�/ '""Cp r i lc� t%! �ln <br /> - W I <br /> Prolec�Address lil knownl I�/`� �b I(�/�� �U'� � i <br /> � <br /> Attach tour 14)copies of p�ane�or proposed wo�k-O�aw to sca�e and note ihe fotlowing as applicable: � <br /> • Property Lmes • Cenirdine ot streel <br /> • Oull�ne and d�me�sions ol ali existmg and • InCir,ate Nor�h <br /> pronosed sirudures on the lot • Show any proposed grading changes <br /> • Shcw measurements M <br /> • E�is�ing and pro0osed uUltlies W <br /> �'-� � DO NOT VJHITE BELOW 1HIS LINE O <br /> I ��� pERfdIT CONDITIONS ��' � <br /> 1.All calis 1or inspection shail be made 24 hrs.in advance•phone 259•881 O. <br /> ( � 2.All work shall be pedo�med in acr.ordance with Ihis permit and cwrent Gty ol Everetl�esign and Gonstruction <br /> � �_ Standards and Specifications. � <br /> ��� <br /> 3.Call Locat�on Underground Service 48 hrs.before you dig.iOLL FREE NUMBER 1�800•424•5555. <br /> p�c l.�loz.�z �.¢o.,� /i�o��'r�..�u',` � <br /> I �.� y�l�.�37oz-��� � <br /> S-f 90 N <br /> ��� � <br /> � <br /> + 1 <br /> �� I � <br /> I �� ACKNOWLEDGflMENT OF CONDITIONS <br /> �I ����� - The undersigned ownedapplicaM hereby agrees to hold and save harm� <br /> � . less lhe Cdy ol Everetl Irom any and all claims for damages. costs, <br /> � ezpenses, or causos o� action Ihat mny anse 6ecause o� Installation <br /> and mainlenance ol the improvemenl or olher righbobway use hereto <br /> applied lor and furlher ayrees to remove same upon notice trom the <br /> Approved lor Con5lrutllon �a�e City and lo replaca public property damaged Ihereby. <br /> FINAL INSPECTION Data Date <br /> Approved as Constructed Si9��alure ol Applicant <br /> WOPK AU7110I717FD BY THIS PERMIT MUST 6E STARTED WIfHIN <br /> (�escrett PUBLIC WORKS DEPARTMENT 180 DAYS OP DATE f'Ei7MIT IS ISSU[D AND THER[Nf 7LN IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO GOMPLE710N. THIS PEHMIT MA`1 8G <br /> UEverett WA 98201 CANCELL[D BY 1HG CITY UPON ANV 51 OPPAGE OF WORK ON THiS <br /> Phone:259-8810 PROJECT OVEFi 80 DAYS DURATION. <br /> '.! <br />