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�.a.,.� <br /> ,.,.�., <br /> ,, <br /> � <br /> ��� w -� <br /> b � <br /> � `° - 3,-Z s � <br /> N y �- 9— 9� Z�-- <br /> } Pi.oM1c W�xs veurn� _ <br /> � � Date_�-L3D141 TO POSTiNG. a-��a> > a�a9 :Je1,, , q,•�h�,�---- <br /> .� � p qpplica�ion For — <br /> ~ CJ K PE R M I T Public WorkS F¢e <br /> � �� ���LIC WOR � Taaifae s — <br /> y �a�zaoo� Faeoa�a a <br /> Q ppOp eau��eo�e S 2-O <br /> �J G l f l O O P 11� O O S U <br /> 7�tl c�i C Print or Type Only� ,a o �, o a o c,� o -a <br /> p[q� �.� [� �D �al d M CJ r. v� a <br /> � \.Y. � M W M N �� M M <br /> x H� �, 347-0870 <br /> > H G E Baker Cona�- In�• 82�H - 44th Ave W #A Mukilteo WA 98z�5 phon= <br /> ¢�p � C�ry Zlv <br /> r�y'�;3 Owner $ $ Q JVj ���j-��� w <br /> O Si� 4. � aaios � ,�+ c�.� -- <br /> H � <br /> n b� ��e= � Cit Zip Phone <br /> Mailin9 Atldress Y <br /> �� [� qpPlicant . . <br /> �� <br /> Describe Proposed Wark � <br /> �� <br /> 482—� � <br /> Project Address IA known� 48XX B1aCk Foiest Iane __ <br /> � <br /> Attach four(4)copies o�Plans for proposetl work-Draw to scale antl mte the following as applicable: � <br /> • Centerline of street <br /> � Property Lines • Indicate NorU � <br /> �0�.+��ine a�d dimensions ot all existing antl � Show any proposed gratling chan9es <br /> propused sVuctures on ihe lo[ � Show measurements M <br /> • Exisiing and proposed uiilities W <br /> �...�'.:p� DO NOT WfiITE BELOW TNIS LINE O <br /> Y <br /> PERMIT CONDITIONS � <br /> . � j 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8310. <br /> ! 2.All work shall be performed in acwrdance with this permit and current City of Everett Design antl Consiruciion <br /> ��. Standards and Specifications. � <br /> 3.Call�ocation Underground Servic2 48 hrs.before you dig.TOLL PREE NUM8E81-800'424•5555. <br /> O <br /> � c� � <br /> � O <br /> , , ,_� <br /> a <br /> . ACKNOWLEDGEMENr pF CONDITIONS <br /> ��� � The undersigned owner/applicant heieby a9rees to hold and save harnr <br /> less ihe City of Everet� from any antl all claims for damages, costs. <br /> expenses, or causes of action ihat may anse because of instaliation <br /> ^ � � L'/ ^ S — C�� and maintenance of the improvement or other rightrobway use hereto <br /> 'iJp F-c.��� Z � applied for �nd furiher ayrees to remove same upon notice from N�+ <br /> ApProved for Construqticn . � <br /> Date City an to replace p�iblic properry damaged thereby. <br /> / <br /> � <br /> -<i �i � �'` .�'_`Z—�� <br /> l. <br /> FINAL INSPECTION Date ' - Date <br /> Si at e ol App icant <br /> ADProvedasCo�struCted yypRK AUTHORIZEU BY THIS PFRMI' MUST BE STARTED WiTHIN <br /> everet[ PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS iSSUED AND THEREQ�TFR iS 70 <br /> 0 3200 Cedar Street BE DILIPENTLY PUFSUED TO COMPIETION.TH!E PERM:i Mnv PF <br /> Everet�,WA 98201 I CANCCLLED BY THF CITV UPO"I AVY STOPPAGE OF WORK ON T�i'S <br /> P�one'.259-9810 PRO�F_CT OVER 9i) DAVS DURAi t.`7d . <br />