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<br /> � Date �d /7 G96 _ v�mi,;wan�sae mi�. �� ' 7"`�9 �
<br /> ApplicationFor - . ame.o9r�+ _
<br /> PU�LIC VI�ORKS PEFiMIT : . P°°;o;�,F o°°° S _
<br /> � leee NpO�Foa Pn10 �_ _..
<br /> Print or Type Only ea�e��so�, S 3✓`—="
<br /> Jl�f!/.FJLTEO SCHCIiG e��/ST,PiC> '��, /�li.�iGTEO./JA -� /827.5 � � -�
<br /> - Owner ' Mailin�Atldress City ° . . � Zip .. . Phone ., ; ,
<br /> G.eoss, Ts,�v,Pmy.r/ �f �mc=.es, /�+/C. 3897-/3>j'i��E tcl, :
<br /> :G�/CkE�o•'v o�u�j.(/E_±Y ����/:E�, SUi>E aoS SEF�lTCE LrIA, � �8��� � � � � �
<br /> Applicant Mailing Address City ' Zip � . Phone
<br /> Descrihe Proposed Work COtiS7'i_'UCT A 1�,2iliEulHY TO /✓Fi�l �
<br /> itav,F��rco .Srs�ooc of}�' ynacri �,P f'r 9GOo a'���'
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<br /> Prolect Addre:s(if known) � � � � �
<br /> Atlach four(4)coGies of plans for proposed work• Draw to scale and note the fo,!owing as applicable: . . � aw .
<br /> d Property Lines � . • Centerline of streel � � �
<br />� s Outlir,e and dim��nsions of all ex���ing and ! Indicate Norih � . � . . ,�
<br /> ', proposed structures on the lo! . Q Show any proposed grading changes': �� :
<br /> . o Existing and proc�osed utilities � � • Show measurements -- . .. ., �
<br /> DO NOT WRITE BEIOW THIS Li��lt
<br /> . � PERMITCOII')ITIONS � _ ' �
<br /> 1. AI!calls for inspection shall be mada 24 hrs.in advance-phone 259•8815. �� �
<br /> ' 2. All v�ork shall be per�ormed in accordance wi�h this permit and current City of Everett Design and Consiruction
<br /> � Standards and Specifications � ,
<br /> �� � 3. Call Location Underground Servica 48 hrs. before you dia.TOLL FREE NUMBER 1•800•424•5555. � � . � �
<br /> J`, � C�iU�^T.�C�cT �E...'� ��PD//E,O v.PAir/ii./fr : �
<br /> .�_'�.�TE.�. /D�/� -,�-6
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<br /> S. .,i.r/Sr9�L TE��o,¢a2y �'o�vs.-.P�GTio�✓ �
<br /> e_n/T/'/��/� Pc� �Si,qti,pB�D ^� 0?08 10/17/66 4=03PH OOOR�f252� �
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<br /> /,�OL��/ E7.e /rlV� �E ,�E.oT �,�Eyg�/ DRVW'1 235.00 �
<br /> �� �C U%�7' .a AEi3.P.S CNEC}; 435.00
<br /> ACK��OWLECGEME�VT OF CONDITIONS
<br /> - � The undersigned owner/aGP�ican!hereby agrees to hold and save harm-
<br /> - . � — less the City of Everett from any and all claims lor damages, costa
<br /> �� expenses, or cauees of aclion ihat may arise because of installation
<br /> � e���,��/� and maiNenance of the improvement or other�righbohway use hereto
<br /> �� � ' �� / ��a� ap�lied lor and fUrthef agrees t0 remOve Same upon notice from th�:: .:
<br /> Approved'or Conslwc;ion ate City and to replace public property damaged thereby.
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<br /> FINAL INSPF.CTION Date =1. I�'�� • Y.WSlMS/l,cr/LJ �,,y�,
<br /> Approved as Constructed Si�naWre of Applicent , �� �. .
<br /> evcrett P U B L I C W O R K S D E PARTM E N T WORK AUiiIORIZED BY THIS PERMIT MUST BE STARTED 'r�,9THIN ,��
<br /> � 3200 Cedar Street 180 UAYS OF DATE PERMIT IS ISSU'cD AND THEREAFTcR IS TO
<br /> Everett,WA 98201 BE DILIGENTLY PURSUcD TO COMPLETION.THIS PERMIT MAY B5
<br /> � Pnon?:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGe AF WORK Ot�Thll� �
<br /> PROJECT OVER 90 DAYS DURATION. , �
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