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� ~ <br /> � ��, <br /> '3 �p/413 <br /> c � H �14-`� --- n„oi,�wa�k�ro�mn. — <br /> � y ti Date� o�n;, o�o� • <br /> H � S Applicalion For _ <br /> y �+ -- <br /> � " � PUBUC \IVORKS PERMIT "°°'",V"""°` <br /> TOl.11{fC 'S� <br /> � � 0 <br /> b M 'E I.essACO�.Fec Pauf S -" <br /> N M <br /> � �alancvDue S �� <br /> o H � Print or Type Only <br /> z H � � � � j 1 V�/1 'L� t��?.�,-� ��� �S�/ <br /> q y � �'�) lh 1'] C") 1� ,�/ �)��vV U�/� �Q�/�Y'� Phone <br /> i <br /> r �y Owner Ma�linc�Address C'ty Z�p ' <br /> .. <br /> �❑i � y l i .r,•� '-� l�d l/1� /,i �-/ l��('L�(�7- �'lLy� �vf�y_���9e ?.�� � S"3. 2� '�_ <br /> � �q � Mai6n9 Adtlress City Phone <br /> y APPlicant <br /> O N r <br /> /��E � �L.-,2;�, C� w�-. ) 7�0 '' � ! '`�'�— <br /> Describe PioPosed Work /� � v � <br /> �p� l/ � '�' , � ��/—�'�_---E�_�---�,-- <br /> W <br /> �_ 7 � �'1 hr� ' I �"' <br /> Prr,jeci Address lil knOwn) " �� � � �V � <br /> �� <br /> lttach four�4)copies ol plans tor P�oposeA work� Draw to scale and nole the loilowing as apP�icable�. � <br /> • Property Lines • Centerline o'street <br /> e Indicalc North <br /> • Outline and dimensions o1 all existing antl � Show any pruposed 9radin9 changes <br /> propo5ed sVuclures on lhe lot • Sl�ow measwements /� <br /> • Eaistin�antl proposed utilities W <br /> (,_�' DO NO?WPITE BELOVJ THIS LWE O <br /> ��� <br /> ' � : PERMITCONDITIONS �\ <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259�8810. <br /> , �,` 2.All work shall be pedormed in accordance wilh this permit and curmnt City ol Everett Design and Consvuction � <br /> = _' Standards and SpecilicaGons. �� <br /> , 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUAIBER 1•800_�n24'.rJS5S�-0"��'� �!'�'=f'"�:''"� ' �_ � <br /> Lr <br /> ,c�. J,p Pl�i G�-�NT 511A�-1... MEE.'r LV RIL� Z.�r: I NC-, 2�Q��Lt��12=�1'�S ^\ <br /> �;PT.�O `•2U.Cii :�j <br /> . � �„ S. 20�COZ�f TO 8� GoNSnt�JcT� AS PE7L L�r�t oFi:lE�r2.E}i`t�•�'•'' <br /> ' . � 3z4 L� <br /> STD, t�� r <br /> '=1�'� �o. �O Fi�l., SHn��L f�E P�_.�.�EU lr�l �F��il.72E 6U�L.i71NC� �� <br /> pP J a i.�:v-• `/' <br /> . a <br /> �_,_, <br /> ,, � <br /> ���� — ' ACKNOWLEDGLMENTOFCUNDITIONS <br /> '���� The un�lersi9ned owner/apn�icant hereby a9rees to hold nnd save ha�m� <br /> less the Cily ol Everell Irom any .ind all claims br dama9es. costs, <br /> ��� eape��es. or causes ol aclion lhat may arise because ol installahon <br /> �� �C I�A � -��90 and malntenance ol lhe improvement or �ther ri9hPol-way usr Ir����to <br /> l appli�d lor and furthur agrees lo remove same �iF^^ noticc irom Ihu <br /> App�ovetl for Cons uclion Date Ciry and to replace pubhc prope.ry dama9ed there�y. — <br /> � ,�-3�- s� � - <br /> ���-- <br /> FINAL INSPECTION Date Dalc <br /> Approved as Consiructed Si ure ol Applicanl <br /> everett PUBLIC WORKS DEPARTMENT <br /> 60 D YSTOF DAT6 PER�1 TSISEISSUED AND THERE�TER ISHTO <br /> � 3200CedarStree� BE OILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED 8Y THE CItY UPON ANV tiTOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PPUJf CT OVER 90 DAYS DURA710N <br />