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/ <br /> ������� /,�� Pu�LCWorkSPvrmtl� — <br /> +—i1 c(� / <br /> � oiea 000� + —Sl.'L� u � <br /> Appucahon For T��_Jl <br /> PUBLIC ONORK� P(ERMIT ""°;aW�eo`�� g --- — <br /> Lr•.sFoOl PcePnia S --_ <br /> Ila�ance0ue � -- <br /> Print or Type Only — <br /> /lJ;.�'n ���Ptu�4fa L I ? ?(• 4 /��'��� �a �P _ <br /> Owner Maihng Address City Zip Phone <br /> , rl,r�� Sr/1��� �� -e ,��ta� fr-�;� �4�� nt�/��'�F2c� .�ZS 9-/75C� <br /> ApplicaM �4ailin;�Fddress City Zip Phone <br /> Descnbe Proposed WorP. �LY� ���� /�P.'Unvl r.�/�/'�ic /� i.�,nn�aiuc QY� -- <br /> •S VJ�[! y1u-�J(-!J11 • — — <br /> - W <br /> Prolect AAdress lil hnowr�i � �—��"��J�`�— � <br /> A'.tach!ou�(�1 copies o:plans lor p�oposed work� D�aw to scale and note the lollowing as appi�cable: � <br /> • P�operty L:nes A Centerline ol strect ♦^ <br /> • Outline antl dimer�sions ol all existm9 and �� Indicale North V� <br /> proposed structures on thc lot • Show any proposed yradmg chnngas <br /> • Existing and proposed�tilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW TFIIS LINE O <br /> PERMIT CONDITIONS <br /> 1.Ali calls for inspection shali 6e made 24 hrs.in advance-phone 25�1-SS10. ^ <br /> 2 All work shall be peAormeA in accordance with this permit and c�rrent City ol Everett Desi9n and Cuns�ructior. ♦ <br /> Slandards and Specificadons. <br /> �'3.Cau Locat�on Undergmund Service 48 hrs.before yuu dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � �^ /f /`�i� r //� o <br /> j c'�/���I^, �(.�-�:-��./.y /...C.;=��J+i.c. �.`�2�� � fL'�ltL�1s-'0" � <br /> 6 — N <br /> , �Z� /�B9 O <br /> 7 <br /> a <br /> ��GKNOWL[DG[�dENT OI` CONDITIONS <br /> The undei;�r�ned owner/applican�hereby ag�ees to holu:md s�ave harm- <br /> --- -- � - �- � � ies; ihe GdY �� Everett Irom any and all Claims tor Aama9es, cost:. <br /> , �:xpenses, er causes ol aclion that may arise because ul in�tailation <br /> ' und maintenanca of ihe improvement or olhor nghl-ot�way usc herelo <br /> _ _ . ._ _ _ _ . _ - . --_ i, opnlied for antl lurther agrees to iemove same upon ���ibri� Irom ihe <br /> F•i-:,�r�.,��; io� �-�.r:,i��,�;�-��, ���"- ' City and to replace public property damaged tnereby <br /> FINAL INSPECTION Date — — <br /> qpproved as Consiructed Signature ol APPlican� Date <br /> WORK iAUTNORIZED BY TFIIS PERMIT MUST BE STAFTED WITHIN <br /> evrrrtt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFIER IS TO <br /> � 3200CedarSiraet BE DILIGENTLY PURSUED TO GOMPLETIOM. T'�iIS Pf_R"d:T 61AY 8[ <br /> F.ve�ett,WA 98201 CANCELLED BY THE G:TY UPON ANY S70PPAGli OF WOHK ON 761IS <br /> pi�cr.�. 259-9�410 pF70JFGT OV[R 90 DAYS DURATION. <br /> O' <br />