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Daka_1• _ ,�— �7 jo � F„���.�w_�,.,P�,�.�,�. ,��= 3j'<ta <br /> I eme oapi.. — <br /> P.ppliwtion For <br /> PUBLIC WARKS PERIVPlT Pu�i¢WoniaFao $ <br /> To1al Fea <br /> lessAOG'-FeeVaid g--�r�-- <br /> Baiance oue g- <br /> �!. � <br /> Print or Type Only <br /> , r-- <br /> r�O�i [ i��LM 4 �� ��l'f C����/�'r-� G,/�i�2`� !���3 ��3 --� ='� i <br /> �'- C�ty Zip Phone <br /> �wnef MaJmg Address <br /> . � <br /> �`'�i i� �%'F�u� 7`�%� ��a.U,����, /'�-�y.� �'�l�%� ��,���_ �G o� <br /> Applicant <br /> �� Mading Address City 7ip Phonr. <br /> _ �-� / <br /> �/p�� .,,C-L�+s.i4 !/� �C��'C'P- <br /> Describe Pro osed Work _SL_ �j/ <br /> / � � - i� . L�a�t <br /> {� <br /> -- �� ��J � - \ <br /> � <br /> — f -1 .�� -�� .y. '�i r - . � <br /> Proiect Address(if known) <br /> , �� <br /> A�tach low(4)copies o!plan;tor p�oposed work- Draw to scale and note Ihe followinp as applicable: � <br /> • Properry I_ines • Genterline of sL•eet <br /> f� Outline and dimensions of all existing and • Indicate North <br /> proposed strdctures on Ihe lot • Show any proposed grading changes <br /> • Existiny and Groposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LWE --- O <br /> PERMIT CONDITIONS <br /> 1, All calls fo�inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All vrork chall be performeJ in accordance wi�h this permit and turrent City ol Everett Design and Constr�ct'on <br /> S'ar.dards an�Specifications. � <br /> 3. Call Locatior� Under9round Service 48 hrs. belore you dig.TdLL FREE NUMBER 1-E00-424•5555. <br /> T,�_>;,9�� % �� ,l�ii9_ CUlrr_=-CT i,� i>ir�i/ � <br /> 1_ <br /> / �� o !' ��:i:�ci-'< T' G-l� .�::-T Til,= ) H <br /> L �� <br /> � <br /> � <br /> U9/24/B6 3�OSFM OO�Aif2'05 � <br /> / <br /> ` �Hn0�0tn0.81940 ���1np <br /> � (��% ACKNOWLEDGr[urn�erI{VTOFf.[YnUrriONS <br /> �,�� -3h'MA}eb <br /> The undersigned ownedappli., y ag���SQ hold and save hann- <br /> less iha City ot Everett hom any and all claims for damages, co.=.ts. <br /> expenses, or causes of action iCat niay arise because oi inst�llati�n <br /> '� � z`� g� and mainlenance ol the improvement or other right�of-way use hereto <br /> • ...��j`��>r�� applied tor ar.d turther agrees to remove same upon notice Irom the <br /> Approved lor ConsVuctionc_v`�--� Date CitY and replaceyublic ProPertY m.�9ed therebY. — <br /> i f <br /> � ;� _ 1 .�c� <br /> �o-,�G-��G , � ✓�--� (1 � ��' C� �_ / <br /> `.k[.�; <br /> FINAL INSPEGTION Date � . Datc <br /> ApU�ovetl as Constructed Si aturr ot Ap ant <br /> WORK AUTHORIZED BY THIS PERMI? MUST BE SiAFTED �NITHIN <br /> everett FUBLIC WORKS DEPARTMENT 180 DAYfi OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BF. DILIGENTLY PURSUED TO GOMP:.ETION.THIS PERMI7 MAY BE <br /> Everett, WA 98201 CA�dCELLED EY THE CITY UPON ANY S'fGPPAGE OP WORI<ON THIS <br /> Phon�: 259�N815 PROJECT OVFR 90 D.4YS DURATION. <br />