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, <br /> ;�-L.� �.G' Puoimwo�xsammu. �O' 7J <br /> Date�-- � c� ��� � =� <br /> Bidg.DeC��• — <br /> Application For <br /> �'ID�LIC ��/ORICS PERM �T Pu�TotlF¢eFee S _ <br /> �essAOP�-PoePai� $ '�— <br /> 6aiance�uc S <br /> Print or Type Only <br /> � 1 . � � i-Y ��7 i� , ""-," l- � <br /> `��� `U��- �-�",�l �Cx'�� 9�-�' �1 ��Q�'A�i� �Y y�, �I �m �(' � , �_�"r_� <br /> --^ Mailing Address Cdy Zip Phone <br /> Owner ���_� <br /> T�� Mailin Address City Zip Phone <br /> A;�plicant 9 <br /> Describa Pro.iosed Work ���'� � ����� ����7 � � � � � �� � � ��� � <br /> '����- C`� I-JI�'�.��111 V�; V�I 1 / I`'� " <br /> W <br /> Prol���l Pddress(il known) <0.�� " T/�C�:SD� /"16"— � <br /> Al�ach fow (4) copies of plans lor proposed work• Draw to scale and nole ihe following as applicable. � � <br /> A� Properiq Lines • Centedine ot ttreet � <br /> t Oulline 3nd dimensions ol all existiny and • Indicate North <br /> ,;toposed sirucW re=on�he lot • Show any proposed grading charges <br /> • I"xisting and proposed utilities • Show' measurements � � <br /> ��� 00 NOT WRITE 9ELOW THIS LINE � <br /> PEF�.MIT CONDITIONS � <br /> S. .I;calls for inspection shall be made 24 hrs.in advance�phone 259•S81 O. <br /> 2..411 wo�'rt shall be performed in eccordance wita�his Fermit and current City o�Everett Design and Consiruc�ion <br /> Slanda!9s and Specilicalions. <br /> 9.CaP Loca�ion Underground Service 48 Yrs.before you dig TOLL FREE NUMBER 1-800-424•5555. � <br /> � <br /> � <br /> N <br /> O <br /> tz. <br /> f�C�(NOWLEGGEIdENT OF GOfJCITIOtJS <br /> Themtlei3�.�^�d:.'.vneUe.pplicaNhercb;_gmest�holdann5aveharm- <br /> -------�--- -------�— less lhe Cny uf Gverell from any and a'�i Gai���is for tlameges. costs, <br /> ezpense�. or c2nses of aclion that may arise because ol inslallation <br /> ' � � antl mainte.r.are of thn imprr.��emenl or o�hcr righPof-way use hereto <br /> i^ <br /> ��/f �:_��7�.�2� Z y<� npplicd lo� a��C '!^��er .�y,:'es to remove :�an,e �pon notice lrom ihe <br /> �' , �:� , , <br /> �pprnpE�I�r ConsiwS;tio�� J � /• .;.�ty and to replzcc. p.iblic r�oper�damaped th=reby. <br /> / L // i^ / I <br /> // � i �;i � 1 p �� / � / ' (il <br /> / y,�����-��� /�' ` �'� _ V I �'v 7,� / .,s ���0 <br /> > i y 4�Q � <br /> INAL ��d�PECTI6N � J � ' C.ate l• . , Dnte <br /> nr;:�ved t:Constr.ictetl I Signature o!Apolir,z.nt F <br /> � WORK AUTtiCHIZED BY THIS PERMIT MUST B_ STARTFD WITHii: <br /> �.�i.���� PUBi.lCWORKSDEPARTMENl 1L� DAYS U° DATE PERM1IIT IS ISSUED AND THEREAFTER IS i0 <br /> � °200Cc�darSireet 6E DILIGFNI�Y PURSUED TO COMPLETION. THIS PGRMIT MAY BE <br /> Everelt.WA 902�1 CANC[LIEU BY THE CITY UPOI1 ANY STOPPAGE Or�vORK ON THIS <br /> Phonn.2!i7�8810 PROJECT C/ER 90 UAYS DURFTION. <br />