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r= � i-z�-4 �Z--� ti-��- <br /> Date2J_5/q� p/� T � ``�� �/ �/ v�o�,�wa,..P..m„. <br /> T� f I1S 1�N IY�;L�L_/� e�eo oeo�• 92/35558 <br /> Applitelion Far � � <br /> PUBLIC WORKS PERMIT °°°;�.�.;`°° . <br /> io.ero�reeo��a S <br /> � . e.�.��.o�. i 20� <br /> Print or Type Onry � � � � � <br /> Donald Cobane SB15A Glenwod AVe ��Everetk. WA 98203 355-9271 <br /> Owner MaiNqpAOdress � , City Zip fhone <br /> awner . , . , . <br /> Appli�ant Mailing Atldress City Zip Phona <br /> Deseribe Proposod Work �e����� oaw dNp]Glt <br /> W <br /> Praject AEdresS(il Y.nown) 5819 A S B GlenwoOd AVe. � <br /> Attac�lour�41 topies ol plans lo�pmposed work�Draw lo scala entl note Iho lollowing�s appbca�le: � <br /> •Pmpeiry Lines •Cenlerlinc ol street /A <br /> •Oulline and tlimensions ol all ezisting an0 •Indicete North V� <br /> proposeC structures on I�e lol •Show any proposed BraOinB��anBes <br /> • Eristinp an0 proposetl uiilities •S�ow measuremenls � <br /> DO NOT WflITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inspection ahell be modo 24 hrs.ln ativance•phono 259•8810. ^ <br /> 2.All work sh��l bo pedormetl in occortlance with this permlt antl cunent Ciry ol EveroU�esign entl Construction �� <br /> Sienderds anG Specifications. <br /> 3.CaIILaationUntlerpmund5ervico40hrs.beloreyoudig.TOLLFREENUMBEfl�•BOD�424•5$5S. � <br /> O <br /> I� <br /> � <br /> O <br /> a <br /> r ALNNOWLE�GEMENT OF CONDITIONS <br /> �'l The untlersi�ned owncqa00�icon�noreby ag�oes to hold and Snve hmm� <br /> less Ihe City ol Everett Irom any an0 all Uaims for Eamages. costs <br /> � /� ezpenses. or causes ol action ihat mPy x�lse betnuso ol mslallalion <br /> LL��� �� 1� kC�., �" �9" ��) and mamtenance ol 1�e impmvement or other iiflhLo4way use he�ato <br /> up0�ietl br antl lurl�or agrecs lo�emovc same upan nol¢e imm I�e <br /> Approv tl lor Consbuction ���� C�Iy and to replaco public propetly dama9eU I�ereby. <br /> �" � <br /> _s�: �"t._C �3o-S3 . , /��� . <br /> FINAL INSPECTION Datc -�x��`�� "`""�'A"�'L �—�" �� <br /> Approved es Conslmcted .'Signature ol Apphcant Di�� <br /> � pUBUC WORNS DEPARTMEHi WORK AUiHORIZED �Y THIS PEFMIT MUST BE STARTED WttM' <br /> 3700Cedar51�ee1 1b0 DAVS OF OATE PERMIT IS ISSUEO ANO THEREAFTER IS <br /> Eve�eq WA9B201 BE DILIGLNTLV PURSUHD TO COMPLETION.THIS PERMIT MP' <br /> P�one�.250�8810 CANCELLED�Y iHE CITY UPON ANY STOPPAGE OF WORN Ot <br /> PROJECT OVER UO OAVS DURATIUN. <br /> I <br />