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i <br />� <br /> �r � <br /> n <br /> � H <br /> ,ozx <br /> �yy [�"�n �.--. __ . . . ._._ _,-----. .. . _ . .___.... . . . .. __. _ __ __ . . .._._. . ._ . <br /> [" � . . ' � �, .. � � . <br /> H � � -�''�' �a'- �. -e �l^�'�''�'"z� �1' i��- ; � �_ . <br /> FQ Q Date 1 �'Za ..•. I 1 _ � : 'ubiic Wor4s Porml�• 7� ��� �, <br /> y x � , �- : 28176 <br /> O C� O Application Foi �..� om�oep�.. ', <br /> � V1 H � Puofm wo�xs Fce � <br /> � � � PUB�IC WORKSW_PERMIT ro„���, § <br /> HC7 i � Less aaot ree aam S ; <br /> � r_ r� � c c '� �_ �aianceDuo 5 2�~ I <br /> �n �y--f Print or Type Only � -�. � �+ �, � -� „ p� :' � <br /> H C�7 V � i�: . •�.tt� o c G r �l r� ,� C,i M r i <br /> � � .\ <!1 � l 4 � 'N bi I�F C i <br /> � n � :.7 <br /> H � �� ... i�. -: . ;„ ` -, �i <br /> e"'. H ' C- '^ � <br /> 9 H x ' Crecksidc Cuoton I�OL'ICA 1D127. i:vez�: _c+<in [jy 1�102 FvPret n�?n4 ;;4_07,7 �., <br /> ty T <br /> Mailin Add�esS� �� Cit = , S , Zip Phone i <br /> H H � Owner 9 ra r=, ,r Y t� r c.� .:. .. <br /> y n <� •o x �� .:.: �� uxc_ .s � � <br /> �� �� ; u c3 �. .� i,i _.. o w O c' -. " :� ',. <br /> �"'� O J J isi �i J UJ .': J L <br /> � t7 cn fL�rk 2;ci:en�ie 334-1757 or iirent II�1dWi�"�:�5069=' � f� a' -, " " <br /> � � C � Applicanl Mailing Address City Zip Phonc � <br /> � C�l <br /> � H (n <br /> r3 O f/� �. i4ew RC.: 1169of living / 440 ef gar LO T � <br /> Describe Proposed WorK `'� — � <br /> 7 � <br /> �, Project Address(if known) � �>�� '-' ' � �I��"�'`- �L• � ; <br /> Attach lour(4)copies of plans for proPosed work-Draw to scale and note the lollowing as 2pplir.able: oe '�, <br /> • Property Lines • Cenlerline of streel � I <br /> � • Outline and dimensions of all existing and • Indicate North <br /> . proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utiliiies • Shoc+measuremenis ,Aq '�� � <br /> W <br /> DO NOT WRITE BELOW THIS LINE � �� <br /> � �'�" ��I PERMITCONDITIONS <br /> !e.n�, 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> � � 2.All work shall he pedormed in accordance with this permit and wrtent City of Everett Design and Construclion � �i <br /> i ,� � StandardsandSpecifications. j <br /> I i 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FPEE NUMBER 1-900•424•5555. � ' <br /> ��"� I : <br /> �--► j 9. ri�s-r rizovi �� �{- or F sr��T' y=Aicrci ►Jc� st-���5 <br /> I � ' <br /> a_� � �i <br /> �q I <br /> �t�� I !� ''. <br /> I � I <br /> � <br /> ' I � <br /> o_ ; <br /> �i I . � ACKNOWLEDGEMENT OF CONDITIONS � <br /> �•! ; The undersigned owner/applicant herehy agrees to hold and save harm- ! <br /> � � less the Clty ot Everetl from any and all clairr�� for damages, cosis. �. <br /> I�'� o�►• (^1�� ezpenses, or causes of action that may arise because of installation � ���.. <br /> � �- lr ,? � ��j-�L and maintenance ot the i provement or nther ri9h4ol-way use herelo � <br /> F��— � applied lor and furth agiees to remove same upon notice irom the I � <br /> , App:oved lor Construclion �a�e City and to repl /public propert ed thereuy. ', <br /> � `— / <br /> � i�. <br /> �, FI�SPECTION Dale � � � � I � <br /> , Approved as Constructed S nature of Ap icant � Dale i � <br /> I PUBLICWORKSDEPARTMEN7 WORK AUTHO IZED BY IS PE MT�MUST BE S�ARTED WITHIN <br /> �. 3200CedarStreet 180 DAYS OF DATE PERMIT IS I ' D ND THEREAFTER IS TO ":�. <br /> BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Ii 4 ��'�: <br /> ' Everett,WA 98201 CANGELLED BY THE CITY UP^V ANY STOPPAGE OF WORK ON THIS �� <br /> � i Phone:259�e8to PROJECT OVER 90 DAYS DURATION. �I <br /> . . ."� .__.__.—.__ ' _ ,_ E . . . _. �� ��,. ?._-... , <br /> -...���� F'' . l 2f � � <br />