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` <br /> �,,,-� -ro xs� tn,� SY— 3 2Z <br /> Date�lofa�q ,— � �9a P„�,��.�•,o,��P�,m:�, <br /> ApPlicatien For e�n� oeo�.• ���—�.5�___ <br /> PUBLIC WORKS PERNiIT °°°°°"'°„_'�° -- <br /> ,o�.�F�� s_ <br /> LessAnolfeaPaJ S <br /> Balance Duc 5 �'Q Cn <br /> Prinl or Type Only <br /> (11, 1/m„��/AJ 7�1/S P! �� �UP/� 3'�S—(Yt1�lS <br /> Owner Mail�n�Ad ress City Zlp Phone <br /> /Vlir-� �1 P�,��� u���`�.(S_�/ `�`��`� SiM1'1�'rt�i � ��✓(�l /,�,'/✓f/,([�� 7��70 _ <br /> Applicant Mailing Address City Zip T� Phone <br /> Describe Proposed Work �� n '��1..� J?) s���•���'�i M�! �-��`�� � -- <br /> �i <br /> Prulec!Ad�.��ss lil known) �� � � �i�(--d-�y��'�✓-�-�— � <br /> nttach���r(4) copies of plans lor proposr.d work� Dravi to scale and note the following as apPlicable�. � <br /> • Property Lines • Centedine of street ,A <br /> • Outlme and dimensions ot e�!existing antl • Indicate Norih V� <br /> proposetl structures o�� the lo� • Show any proposed c�radiny changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONI�ITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in ad��ance-phone 259-8810. ^ <br /> 2.All work shall be pedormed in accordance wilh ihis permit anA current City ol Everett Desgn and ConslruN,ion ♦ <br /> Standards and Specifications. <br /> 3.Call Location Under9round Service 48 hrs.6efore you dic�.TOLL FREE NUMBF_R 'i-800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> Ai;KNOWLEDGLMENT Of CONDITIONS <br /> 1 The untlersi9ned ownedapplicanl hereby a9rees to holtl and save harm- <br /> iess the Cdy ot Eve�ett Irom any and all claims for dama��s, wsts. <br /> �/ �� expenses, or causes of �ction ihat may ari5e because. ot in5tailalion <br /> //, and maintenance of the improvement or other nght�o4w;:y use hereto <br /> y 2"� ����_v "�9 lied lor and lurther agrees to remove same upon notice Irom Ihe <br /> Approve vr Constructio a�� Cit and to place p hc property damaged Ihereby. <br /> L� �r�`�����/�/r�_`� <br /> FINAL IVSPE� � Uate � <br /> Approved as ConSiructeA S 9nalure ol Applicant Date <br /> evrrelt PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS PERMIT PdUST BE STARTED WITHIN <br /> , 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK.ON THIS <br /> Phone:259-8810 pROJFCT OVER 90 DAYS DURA710N. <br />