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Date 2 �' �•' <br /> 8 Puphc WOrFs P�rmil n �L-` <br /> Applica�ion For Einq ocn�., __��-��,3�8'—- <br /> �UBLIC W�'JRKS NFRr+�99T P�����w�,�gF�� <br /> .o�,�F�� s__ _ <br /> �essnnni �reP.��a S <br /> Prinl or Type Only e,�.,"=E���,. 5 :�% �� _ <br /> ���� -3�!- ��'-�!c-//-5'�/ <br /> �1Sy- ,3�5 <br /> l)�► .D 1� vnr{��UP.�� � �Pr Lu,Enb' � /•dtu��_'?r !�l��P��P✓s� ..3 <br /> Owner MaiNng Address Ciry Zip Pho���(% S <br /> �IJ�.�I 'L�n(SDYL- SG �w a�!'rOnLs`s i��Lc�----c��� -- <br /> Applicant Maihng Address City Zip �'' Phone <br /> Describe Proposed Work /I��W h/��/Y"�`[J L��/<� f/�////�Ai%j�C��L� <br /> P:oiectACd�ess�if knownl _ �z9 — E Cl�rL�'w+�_1.5. �,..�a_ � <br /> Atlach four(4�copics ct plans for proposed work- Draw to sr,ale antl note Ihe follov+inq as applicable: � <br /> • Pronerty Lines • Genterline ol street � <br /> • Outline and Jimensions of all ewsting and • Indicate North <br /> prop.sed sirucWres on the lot i Show any proposed grading changF � <br /> • Ex�sting and proposed utihties • Show mzaswements <br /> DU NOT WRITE BELOW THIS LINE � <br /> PERMIT COIJDITIONS � <br /> 1.All CallS for inspeC�ion Shall be made 24 hrs.in advance-phona 259-881 O. � <br /> 2.All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O'7� s<��- r�°C�r�e. .l- /� e-�">r.�l� �c.; r• �,,, ,�j,_1��.�.<,� <br /> ���(--:; .✓ c/ .i���/' i_ —� _—riL4 �.� /='<F !' `�'. , ._ � - <br /> � i. � <br /> � <br /> O <br /> �i!'c5/89 10:09Fi�i DOOAH4215 � <br /> / <br /> II0001k580 <br /> DRVW'1 235.00 <br /> ACKNOWLED�GNT OF�+'(�IBUTfIONS � <br /> � <br /> Thv undersigned owner;applicant hareby agrees to hold and save harn� ��, <br /> � less�� ihe Cily ol Fverett Irom any antl all claims foi damages. costs. � <br /> expenses, o� causes ol action ihal may arise because of installation <br /> and mamtenance of Ihe improvement or other right�ul�way use. hereto <br /> !=�� ���`�� '-� �-�' "''% applied lor and iurther agrees to remove same upon notice ircm the <br /> Apprc lor Cons ruction Date <br /> � /� , Cit rep�ublic property damaged thereby. <br /> / ��.�._.. �<� <br /> ( �.', . ��,-,�� /��/%; ;=: _ �� i z d � <br /> FINAL INS E TI IJ� �— � Date � <br /> ApProved as Constructed Sign ure of App6cant Date <br /> ever:;i PUBLIC WORKS UEPARTMENT WORK AUTHORIZED BY THIS PERMII' NUST EE STARTED WI'fHIN <br /> 3200CedarStreet 180 DAYS Of DATE PERMIT IS ISSUED aND THE(7EAF7ER IS TO <br /> I� Everett.VVA98201 BE DILIGENTLY PUHSUED TG COM1IPLETI JN. TI;IS PERI.^.IT �1AV BE <br /> l Phone:259�8810 I CPNCELLED 9Y TFi�CITY UPON ANY STO'PAG[OF VJORK ON 1 HIS <br /> PROJECT OVER �.G DAYS OURATION. <br />