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r.-_ <br /> ,.�e� <br /> � A - iL- .�Y� -<(- j, <br /> DBte 3-31-9� ��` q p Publ¢workeParmil• �Z/� Z' =�.--_'" <br /> ApplicationForTO PO�TING 7����-/� emAoea�.• ^.r;iNS <br /> PUBLiC WORKS PERMIT PUOTo1.iFeeFoo $ <br /> H �' I <br /> ��� , _ -. ' ' Lesa AoO��Fea Pa tl $ <br /> � t � <br /> . � i �i i_ ', r ' UaiancfD on � S'r�i� <br /> ��� � Prinl or Type Only , , �, , _ i , � o ,n � tn � - � � �,� � � <br /> H i �� t� t C•1 o i r � r > > � ��� w <br /> 4y . 7 �� �i M aa .N Lw M M . �� <br /> a H V1 �I p �� ,c .� �n y r� �' N .•.:. <br /> iti: + oJ <br /> � �H Hir. ilaYu Horr.�:;. E�21�n.7uh �ve �E x Evai�ut[r98208 x 338�194�ii ��� <br /> K y� Owner .-Mailiri9iAddlessc� c� �r: :� `z " �-i(�� o r� c� x � ZiP_ o � o �;� -� Phonn . <br /> r. r a �- �� nc� i, �„ '_• � � �- n mc.a .. oro -' - � <br /> .:� ty - _J J _ � _.i O S O J U� .J r1 C i:i �-+ -- <br /> O CC O r;i vc u - _c iJ o.� �.. �.-. o r. _:r a � a �_ �� �`_ .�. .� � z .. � i.i <br /> � yH , � _ ... � . <br /> Cwn�r <br /> � z r Applicant �lailin�Address City Zip Phone <br /> � y d - �k censtructlon SYP. <br /> Descri6e Proposed\NorA _ '�- <br /> H �g � <br /> �i]V � <br /> x y�y '� <br /> � Hy W ; <br /> y 16 Glenwood Ave I <br /> N Prole��Addre55(ii knOwn) — I <br /> gd� � <br /> � �r Ntach lour 1�11 copies ol plans lor proposed work-Draw to scale and note the lollowing as 3pPlicable: � � ' <br /> :�7 • �roperty Lines • Centedine oi sireet ♦� <br /> y �y • Culline and dimensions ol all ex�stin9 and • Indica[e Norih ��� ' . <br /> prcaosed siructures on the lol • Show any proposed 9rading Uianges � . <br /> • EsiSting and proposeA utilities • Show measurements � <br /> a� <br /> DO IJOT WRITE BELOW THIS LIN[ � I ! <br /> . � PERMITCONDITIONS I � <br /> 1.All calls tor inspeclion shall be made 24 hrs.in advance•phone 259•8810. � ' <br /> 2.All work shall 6e pedormed in accordance with ihis permit and current City of Ev�rett Design and Con�ti�clion � <br /> Slandards and Specifications. <br /> ''�� 3.Call location Under�round Service 48 hrs.before you dig.TOIL FREE NUMBER 1•800•424-555b�. � � <br /> w � <br /> , , tr <br /> � -, � <br /> �.�, ...� C o����� w;-��i � l� c c.� 1 c.��� -{ ;cr� J �JY� ��,i���� <br /> �, .,� <br /> ` � ^ , � <br /> 1, � ... /� �:_:/ /.:/C j _I � �,i r�c_ - _ ` - `,� � ; <br /> �= <br /> � <br /> �� +� � � <br /> !�� .�.' /�� 11'1'� �J ACKNOWLEDGEMENT OF CONDITIONS � <br /> J�' �p The undersigned owneVapplicant hereby agrees to hold and save harm� <br /> ! � less �he Cily ol Everett Irom any and all claims for damages, cosls, '� <br /> �IA � expenses. or causes ol action ihat may arise because ol installation i <br /> �� �.�� 1'_ ,,, '�^ _�)_�) l and mamtanance ol ihe Impwvement or other righ4ol�x�ay use hereto <br /> M1__�..K_ i applied lor and iwlhcr a9rees lo remove same upon ��otice Irom the � <br /> Approved or ConS��uction j� --- Date Cily a��d lo replace puLlic property damaged ihereby. <br /> i <br /> � / <br /> �� �.: � �.___ ' ' � ;� " . "'i ' . i <br /> FINALINSPECTION ��� Dale -/����� ��"�- � �-'��- <br /> Approved as Construded ��-5(9natu•e�of Applicant � Date <br /> ����� PUBLIC WORKSLEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHW I <br /> 3200CedarStree! 180 DAYS OF DATE PERMIT IS ISSUED AND THERE�FTER IS TO <br /> Everett,WA 98201 BE DILIGENTLv PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�88�0 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PRO.IECT OVER 90 DAYS DURATION. <br />