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1 <br /> �� � <br /> o� x <br /> 9H �n <br /> H � � <br /> K f] <br /> H�7 <br /> ��' �p � 88— 329 <br /> yy Date��/�p� I r�on�wo,.�a�,mn. <br /> �}�� �' B�4A DePI ��� <br /> p� qpplicahon For — -� <br /> H <br /> PUBUC WQ,'��CS PEEtMiT °°°'��"'°,"�`° <br /> ��8 , ,r��eo 5 — <br /> �r � LessAoo�fcrvPeiCS��— <br /> Balenco Duv § ��� <br /> y y� Pn it or Type Only <br /> C� <br /> �"� <br /> gy <br /> H <br /> ��y _f �/rv f L �na�A 7avuiP � /dSDS l�ell�� l)r A�1 /f ��uiaY�/ 9�F7,p� <br /> � � p� Mailing Address Cit Z�p Phone <br /> HOVwi /'�'.,..,,.��n/. Ib�- (�@nS� ��C _�Zato�v11¢�1�nn /qV ��Lc•/ 35.3'774'f) <br /> �' Applicant M�ningAddress Cily Zi� Phone <br /> DescribeProposedWork �/v�•�ip- �Mc-�L�S�.C�1'-+��-�- �f ��ad ��Kp / Q[tlllnlUi <br /> _ --- � <br /> Project Atldress lil knownl 'ZB��- hf`Pp�p-�s—�f/Q�`-- � <br /> i <br /> Attach lour(4)copies o!plans lo�profosed work� Draw to sr.ale and note thz lo nwing as applica�le: � <br /> f Properry Lines • Centerline ol street ♦^ <br /> • Outline antl dimensions ol all ezisling and • Indicate North V� <br /> proposed strudures on Ihe lot • Show any proposeA 9i.ding chanqes <br /> '�1 • Existing and proposed ufilities • Show measmements /y� <br /> ' ' DO NOT WRITE B[LOW'iilS LINI: O <br /> � <br /> PERMIT CONDITIONS <br /> e�' 1.All calls tor inspection shall be made 24 hrs.in advance�phon�.359•NE31 O. � <br /> I� 2.All work shall be pertormed in accordance with this permit anC curre:�d City ol Eu��rett Desi�a 2nd Corstruction <br /> � ' Standards and Specilications. <br /> � 3.Call location Underground Service 40 hrs.before you dig.TOLL PREE NUTABER 1•800•�:4-5555. � <br /> ii � P��. ��°� � ����� �.�,a w���, � O <br /> 1_' C_� .��'�-���- `� (~/� <br /> -i O <br /> -i a <br /> - <br /> _� <br /> ' � — - ACKNOViLEDGEMENI OP CONDI110NS <br /> The unAersigned owner/aFPI'c int hrreby agrees to h-19 and save harm� <br /> less ihe City ol Everet• I�o�n ary and all claims lur damages, cost;. <br /> � ..,�2 exper,;es. or causes oF aU��r thcJ may arise because of inctallalion <br /> f� �/7 .1B and mair.tenance of th� ;mp-ovemenl or other righl�ol-way use he�eto <br /> � __ � V gppli]A ;Of 0�d I��IhBf 3jlCBS IU '�f�OVC 52rt1C upon no�ire irom Ihe <br /> Approved lor Conslruchon - , Date City ana to repiace pubLc propeny d�:naged thereby. <br /> � ' � ' � . , <br /> � � ,. � <br /> --�G���/- � G�-- � G�f' � / � � Ii �-<< <br /> FINAL S�fN PECTiON Date : •� _:'• •_:—�-•-----C-�--•. •�_�� <br /> Approved as Consiructed Signature ol Appticnnt Date <br /> W O R K .4 U T H O R I Z E C B Y T H I S P E f 1 M 1 T I J,�S T B E S T A RTED �VI7HitJ <br /> everrlt PUBLICW�RKSDEPARTMEN7 f00 DAVS OF DATE PERMIT IS ISSUCD JND TH[REAFTER IS TO <br /> � 3200CedarSireel f�E DILIGcNiLY PURSUCD TO COIdPIEiION. THIS PERMIi IdAV �L <br /> Everett,WA 98201 CANCELLED�Y THE CITY UPON ANV`TOPPAGL OF VJORI<ON THiS <br /> Phonc.259-8810 PROJEC7 OVER 90 DAVS DUHATIGN. <br />