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� <br /> ��� <br /> � HtA <br /> H � � <br /> FC c� <br /> � H�i ;U <br /> M � `r, � ' ' n,inecwo��.sn.,m�� <br /> y y� ��� i,.M..� . t�,— ^� <br /> 5� Date ni„� o��o� • —�?-1--�.�' I <br /> L�1 O � APPlica!�nn For -______..____ <br /> �3 �J PUBLIC W�n�S PERMIT ""°"_'""'""Ce <br /> OH tom�v�e 5----- <br /> N �Q Less Rn�� Frte Pma $ —' <br /> �Y (] <br /> �..� y� e�i,,�,��o�� 5 -- <br /> t Print or Type O�IY <br /> �yHH � <br /> Oy l ���r� �i��r�q8a�`�� �����-L-I6�.� <br /> O G y � �1 7,p Phone <br /> � � Maihng Adtlress �'�Y <br /> Owner <br /> � o y �. ,�,, �+ 1�=�� r� ����1� �';� �s�v I'�?P)�_�e.�a_ Z,���.3�3�L�� <br /> Z X Y�a i Phon� <br /> qpplica�t hlaihn,7FCdtliss City <br /> Descnbc Proposed�tibrk ��� <br /> W <br /> pwlect Address 1it knownl H <br /> Atlach lour(4)�opies ol plans for propoSP.d wo�k� D�av+�o scale antl nole Ihe followmg as apolicable: � <br /> � CCOICf1i0P.O�SI�BC� <br /> • Property Lines • Indicate Norih <br /> • Outllne and d�mens�ons ol all eKisting and � Show nny proposeA 9raAin�changes <br /> proposed siruclures on the lot � Show measurements M <br /> '�' • Exisiing and proposed ulildies W <br /> ' ' DO NOT WRRE BEIOW THIS LINE � <br /> � <br /> PERMIT CQN�ITIONS � <br /> '�� 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> ' ' 2,All work shall be pedormed in accordance with this permil and wrrenl City o1 Everett Desi9n and Conslruction <br /> StanAards and Specifications. � <br /> � 3.Call Localion Underground Service 48 hrs.helore you dig.TOLL FREE NUMBEF 1-500•424•555 . <br /> � nc� ��. O <br /> � r���.��I�` �« �' <br /> � � <br /> _� , � << - �:�; p <br /> � a <br /> 1�' ACKNOWL[DGENIENT OF CONDITIONS I <br /> _- The untlersi9ned owneUaPPlicanl hereUy agrees to hold and save hanm 1 <br /> I <br /> lesc Ihe City o� Everell from any and all claims for damages. c�sts. � <br /> expenses, or causes o� ���ion lhal may anse because ol installation <br /> and maiNenance ot Ihe imP�ovement or other righPol-way use herelo II <br /> app�ied for and furlher a9rees to remo�e same upon nolice Ircm the <br /> ApproveA lor Constmc�ion Date Ciry and lo replace public p�operry dama9ed lhereUy. I <br /> FINAL INSPECTION Date � Date � <br /> Signa�ure ol ApPl�cant <br /> Appmved as Construtted WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED V.'�THIN <br /> Oeverect PUBLICWORKSDEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTEF IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO CO�APLETION. THIS PERMIT 1!,aI BE <br /> Everelt.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�88I0 PROJ[CT OVER 90 DAYS DURATION. <br />