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I <br /> . � _' i <br /> � v�m�c wa,.s���,mn, <br /> Date G/?7 �0 9o/'49i12 �, <br /> emn Ucm • <br /> � qpphcation For . <br /> PCl�3l_iC W�JFiKS ��RMIT "°°�°"'�„5FC S - ' <br /> =�`r'y� ro�r���� � <br /> �]r , LessPo�I.i'ee PaN S . <br /> a`� � NolanceDue $ �� <br /> fi�A� <br /> �- I Print or Type Only � <br /> ,-+ . <br /> � t•� <br /> I� Psw,' :;:elsen ].311 �:o;+t T:ve. i,'vcrett 49?Ol 259-G109 258-3333 , <br /> ,*: �` �� — <br /> H 77 Mailin9 Address City ZiF Phonc <br /> �a x p I Owner � <br /> �� .�.� <br /> G:H G"aR1CT <br /> I� C' — <br /> � z$ Mailin9Atld�ess Cily Zip Phont � <br /> �j p[7 ��, qpplicant <br /> �J C� � <br /> H t��'7O �. DescribeProposed Work AdditiOn to ^PR ._� �' . <br /> �� n <br /> r-i 5 __ — <br /> 7H3 I <br /> y C' <br /> "' � - — <br /> _�y — � <br /> pv'� ! ------ — <br /> �; r��n � 1311 Ho;t � � � <br /> S �Cy Proizct Address(if known) __— — — — <br /> T� � " Attech fo�r(4) copies of plars tor preC�'sad work- Draw to scale and note Ihe following as aVnlicabl¢ � i <br /> r� ti U) • Cent�dine ot st:N�,t � ',, <br /> � p V� � • Proper�y Lines <br /> • Outline antl dimensions o�all exisGng and • Indicate Nor�h � <br /> proposed slrucWres on ihe lot • Shovi any propos�d���adin9 chan9es � <br /> • Exieting antl p�oposed utilities • Str,�o measurements M <br /> W � <br /> '�, DO NOT'NHITE BELOW THIS LWE /� �. <br /> PERIdITGONDITIONS ��� <br /> �� +.All calls fur inspeclion shall be made 24 hrs.in advance-phone 259�8810. � ' <br /> �� I .:li v:ork shal!be pedormed in accordance with this permd ans cunent City ol Eceretl Design antl Gonstruction <br /> � � � Standards and Specifica�lons. <br /> "^"! �� 3.Call Wwtion Underground Service 48 L�s.t�fere you tl�y.TOLL FREE NUMBER 1•800-424-5555. � <br /> �_,.... . �+ � � ' � . � . . . � . : . . . . _. � . <br /> i . <br /> '., , � . . gra+a! <br /> e <br /> ..a.. .� ` � <br /> 9`��'� I 6.� ', <br /> _ � <br /> . <br /> I <br /> [ 'j � <br /> ACKNOWLEDGEMENT OF CONDITIONS �i <br /> tk�. The undersi9ned owner/applicant hereby a9rees to hold antl save harm- I. <br /> w1 � — less Ihe Cily ol Everetl Irom any and all claims for damages. costs. <br /> �� expenses, or causes of action that 'r�ay arise bvcause ol installaiion <br /> �� and mainlen.nce o! ihe improvement or other righl�of�way usr here�o <br /> applied for and furlhrr aqrers to remove tame upon notice ��om �hc �, <br /> � Approved for Cons�ruction Date City and to replace pubhc pmpeny damaqed ihereby. <br /> FINAL WSf�'.CTION Date Dale � <br /> I ApProveA as Consiruc�ed Si9naWre nl Applicanl .. <br /> WORK AUTHOFIZED BY 11115 FERMIT MUST BE STARTED WITHIN <br /> everen PUBLICWURKSDEPARTMENT �gp DFYS OF DATE PEHMIT IS ISSUED AMD THEREAFTER IS TO I <br /> � 3200Ceda�Stree'� I OC DILIGENTLY PURSUEU TO CUMPLETION. THIS PEPM11i7 MAY B[ <br /> � Everett,WA 382a1 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:25B�8810 PROJECT OVER 90 DAYS �UflAT�ON. <br /> _______ � <br />