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�- <br /> ApPliwlion Far Z/4'.��` <br /> G�✓� �l1BLIC V1►ORKS PERMIT °a'e ' `'T _ � <br /> �� PUBLIC WORKS DEPARTM�NT Publicl�orks Pertnit p �'� 0 3� <br /> i <br /> 3200 Cedar Slreet � <br /> Everet�,WA 98201 �`9-881� Building Perm�t t�_ - <br /> Public Works Fee a� -� <br /> TYPE OR PRINT ONLY <br /> C{..�^ Q� P� '�i c '� 1 � phone � <br /> Owne� Ma 4ng Address ��L�'��1�. ,.., �LL_ ' <br /> {�O w�s c�w,.�,�s �s tJ. ��` � _ 90;�:, 252 3Z���b' , <br /> w p I <br /> r.-4�L.G�_� {'��SC.�TL-'�� .. Z� Phone <br /> -"-""' Mailing Addre.;s City P <br /> 1- Applica�� <br /> Describe Proposed Work <br /> � � g �- W <br /> r r�a�-��s,-n�crG-�-- ��-t-+�4-1.,�� �, �— <br /> ��� � � <br /> -- �/4 � <br /> PROJECTADDRESS(ifknown) ��'� --�""—�6'-V��— � I <br /> AUach tour(4)copies of plans foi proposed work-6raw to scale and note the foRawinq,if applicabie: � <br /> •Prop=rty Lines 'Outline and dimensions ot all existing and proposed strw'��rr<on the lot •Exis'ing and proposed utilities � i <br /> •Centedine of street 9ndicate North •Show any proposed yradiny:.i;'p� 'Show measurenenls <br /> _ .�—�-a.-n` ."'_��� <br /> ��" DO N')T WRITE.4`+i�F 1 iSS LINE � <br /> PERMIT COND!TIONS: <br /> 1. All cal!s tor inspection shall be mada 24 hours in nd��ar,ce- phone 259-SE10. O <br /> 2. Ail work shall b�performed in accordanca�vith this permit and current Ciry of Everet�Design and <br /> Construction Standards and Specifications ■ <br /> 3. Call Location Underground°ervice 48 hrs..hefore you dig. TOLL FREE I�UMBER 1-80U-424-5565• � <br /> t` �Z ��o1�1G OGti�rS 4SSi�, cSllalL 6�. � <br /> � , / <br /> /^G s�7�,c r 6 L C 7�r- h�4 in f'ch4ncc o� t'�-' ��tl'� , <br /> a <br /> ACKNOWLEDGEMENT OF CONDIT,ONS <br /> '7 / � The undersigned owner/applicant hereby agices to hold and sa��e harmless <br /> � ` � � the Cit of Ewrett from any and all claims for damages,costs,expenses,or <br /> � c� l d� v <br /> causes of action that may arise because of installation and maintenance of <br /> Appm dtorCc•.•; tion � theimprovementorotherright-of-wayuseheretoappliedlorandtudheragrees <br /> �j� � to ve same upon notice from lhe City and to replace public properry <br /> � amag thereby. �\ <br /> ,/�.L%Q�� �, � /��} _ <br /> FINALINSNt�'ION Date \� 1 / xl/ <br /> App�oved as Construr,ted �— � � ^ �{� �� <br /> ignature o1 Appli:ant � �� Date <br /> COIdPLE�'GN.T�HES�PEfCM1T MAY BE CANCE B EDTBYTriE CIT"7UPON AN S�TOPPAGE OF WORK ON THIS PROJEC OVER 9D YS DULRATIJN Y PURSUED TO <br /> � <br />