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Dat��/ 89 �` ���%-/l% <br /> » P,�ni¢Ylo,x.PermO• _ _ _ <br /> Bhf9 OePt � ___ <br /> APPIir.aGon for �, <br /> PUBLIC WOR�(S P�RMIT `'°°��°W°�MSFOe --- --- <br /> 0 <br /> ,�„�F�� $- <br /> pU Lesa Aynl �ar Pnut § <br /> O O P.nimm�•Due S ��nL' <br /> Print or Type Only � o 0 <br /> .�+ N Pl <br /> W M <br /> N <br /> An. b�� \� CV.rT� S P � , '15 � 8�,G��N�1 ��eret+ t*1o, q8ao ► '��9 �S9o7 <br /> Ow er Mariing AAtlress� o r� � Gty 2ip Phone <br /> �i orw <br /> ri � cc=_, <br /> 0 <br /> Applican� Mailing AdAress C1ty Zip Phone <br /> Describ�Proposed'✓✓ork � V-�� � e N C '� U'r�V'N� � h Cl��'r� Y <br /> 3Z ~ Ni�,s�. - Po,e r,o.✓ oN �o f�J- u���c_�F ,�i�H <br /> d�€//,.yo s•o�w.9�.f- W <br /> Project Address�il knownl �-l��8 F GQ��✓� 'QvF_. � <br /> Attach iour(41 copies ol plans lor proposr.d work• �raw Io scale and note Ine following ..s apPlicable�. � <br /> • P�operry Lines • Centerline ol streel � <br /> • Outline and dimensions of ail existmg antl • Indicate Norih <br /> proposeA slrudures on the lot 4 Sho�a any proposed�iod �c�changes <br /> • Ezishng and proposed utihties • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed in acwrdance with Ihis permit and current City of Everett Design and Construction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL fREE NUMBER 1•800•424•5$55. � <br /> �� .. �, , ' . O <br /> ���r� .ol�.cc /� ��. /..'� r �-z,� � / « ( lf'�-���•� ,. 4� x ��,�.��.1�� <br /> t� � �.�`'� �-�.�ry n:���� .� � _ ,t c'f <' r � � � ^ � <br /> � � f z'%� � <br /> / /,.l-�/ � � -�' <br /> : ,, � r' � �,. , --% � <br /> � <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> i nu und<;rsigned owner/app�i�ant hereby ag�ees to hold and save harm- <br /> � -- less Ihe Cdy of Everett Irom any and all claims lor damages. cosis. <br /> � � expenses. or causes ol action that may arise 6ecause ot installation <br /> -' _� ,,/� „ _ i�'� �' -,�; and malntenance of ihe improvement or other nght�oPway use hereto <br /> � � � � ��� T ���' `, '�� � appfied lor and furiher agrees lo remave same upon notice Irom Ihe <br /> .AUpro�onstr ctlon ��e C�ty and lo replace public pronerty damaged thereby. <br /> ��� / <br /> f JG,f � ,� ��� ����� 3 � 9 <br /> FINAL INSPE Date �� <br /> ApP�ov Gonstrucled Signatwe ol App6cant ��� <br /> WORK AUTHORI:'ED BY THIS PERMI MI:ST BE STARiED WITHIN <br /> eveu�u PUBLICWORY,SDEPARTMENT �d0 D�YS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS t0 <br /> � A200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAV BE <br /> Everett.WA 99201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVFa 90 DA1'S DURATION. <br />