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� � �„� Date�•�B r�m��wo,h:va,m�i. SU - �! �_ <br /> � � Bmp Oeo�-• <br /> H <br /> Application For <br /> = y PUBLIC WORKS PERMIT °°^°°w°«•�°° $ --- <br /> ,e,e�F�o <br /> ��sa nooi Fcc va�o 5—��/)�-- <br /> �' � Balance Oue $ �"�" <br /> o � o Print or Type Only <br /> ro N H <br /> �a z <br /> o � D;=l�n/�,� ���G'Y'�4 `f 6.> 3 � L 1_=N �voni, /�vr /-"v�r;F r T IN� 9 8�0� <br /> pp n � Owner Mailing Address Cdy Zip � Phone <br /> � � <br /> � y � sf�M�� 3 3 9 /�l �' <br /> 7�. Applicant Mailin9 Address City Zip phone <br /> M <br /> N /� p <br /> � � r DescribeProposedWork C� ��L1'� �1 nr' l�t rY �('� C�(� �ti'C1rT �X/S�T/N(- .$,L�/�r' d' <br /> � � S2 ssl.�C'� ��n Pr- r r R�g�-En B�� %Ro�,� R,E��,9�>�' o F <br /> S /'T�„ ,�JLSb, G.4'FJ��i�/G � STQ OF GA2.06rN �ON <br /> Project Address(il known) "/ U .1�� G L/_?/Y LY'nOh /�V. �V��C�T �'v �v.�+'� � <br /> � <br /> Attach four 14)copies ol plans lor proposed work- Draw lo scale end note ihe following as applicable: � <br /> • Property Lines • Cenlerline of streef /A <br /> • Outline and dimensions ol all existin�and • Indicate Norih V, <br /> proposed structures on the lot • Show any proposed c�radinc�changes <br /> • Existing and proposed utilities • Show measurernenis � <br /> DO NOT WRITE B[LOW THIS LINE <br /> ��� PERMIT CONDITIONS O <br /> i��`, 1.All calls for inspeclion shall be made 24 hrs.in advance-phone 259•881 O. � <br /> ' 2.All work shall be pedormed in accordance with ihis permit and current Cily of Everett Design and Consiruction <br /> Standards and Specilications. <br /> ' J � 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> I � O <br /> �� <br /> I�� <br /> I a� OS/09/88 1�:11FH 0004�k0495 k ' <br /> / <br /> HOOp976B0 <br /> � � ��� �i�T=D�� DPT.20 g�0.00 � <br /> �,�� � ) f G CHECf: f20.00 � <br /> �j�/ ��G� . ��o �'. <br /> . �i—I �J ��j� <br /> �I � O�6 Q` �CKNOWLEDGEh1ENTOFCONDITION.`, <br /> C G Theundersignedowner/appliwn�herebyac�ree5toh<'i:.����.�,�s:n�clnum <br /> � less the City ol Everetl Irom any and all claims tor �!amagc; cust�. <br /> f '_ `„�//�%� J'" // expenses, or causes of ac�n �hal may arise b�cause eY install:�Lon <br /> af% and maintenance ol Ihe Im rovement or cther ri ht�ol�wa use herclo <br /> /K� U C� 2 -s c� 8a applied lor d Iwiher agrees to remove same upon notice Irom Ihe <br /> Approved lor Consiruclion Date <br /> �- � //� C�ty and 1 re lace public property dama9ed there6y. <br /> /�--�! �._'��-�� ' -J � � `�/ f <br /> FINAL INSPECTION / Date � /�/Z� � I `y� <br /> Approvetl as Construcled Slc�nature ol Appli � Date <br /> everett PUBLICIVORKSDEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DI:IGENTLY PURSUED TO COMPLETION. THIS PERMIT M�Y 8[ <br /> Phonc:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Pf70JECT OVER 90 OAVS DURATION. <br />