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Date /� �I PubicWoihsPo�mi1♦ / �— /?�_ <br /> Application For aiee o�u�-•—g� — 2 �9�� <br /> PUBLIC WORKS PERMI� v�°,ow,F�aF°� § <br /> Lecs AoO�-Fee Paid S <br /> Print or Type Only Tn Po�TINf 3 ��%� °"�"`°o�� s /7A-i�� <br /> Ob/2p/91 1D:56F�M OOOpH7505 KKk.0 <br /> ,�/J�, Es-TF� i�.�i l�it eKER ,4V�, �d�,P� r�,��{0�,9 =,pzh osn-� - 5�9:z8 <br /> Owner Mailing Address Ci�y ziP DFT.�O :�?J.UU e <br /> S���� PW PC 8105.76 <br /> FWTNSF 4hf�7.^S <br /> Applicant Mailing Address City Zip DFT.20 $9���e <br /> N00026911 <br /> Describe Proposed Work L'�E/�/Q .S/�� b� �)P SC7 /L � .��iC��$4S�,�Q//�r�/��E_ <br /> SYST,E�1 AN n C o�.s'�'i'�(c7- STiPE E I /�tA'�'�POV�'����N��"5 <br /> i�—��— <br /> F.t A N�w /7 in '-Sfo�a Cvm CC a 73 <br /> �2p _ - /r/�•�'••�e l'iesJ Qr E�LDG i144.00 � <br /> %c�� ' '�-�:-Tv�c' E!/.C--R�- !�/�9- ^ ^ � <br /> Prolect Address(il known) ( <br /> Attach four(4)copies of plans lor proposed work- Draw lo scale and note the lollowing as applicable:�DG $317.OQ — <br /> • Property Lines • Centerline ol street F SRCH ^ 84.50 � <br /> • Outline and dimensions of all existiog and • Indicate North CHEG. 4�844.96 <br /> proposed siruclures on the I�t • Show any proposed grading cha�iges <br /> • Existing and proposed utilities • Show measuremen�s � <br /> —r <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All cails for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and wrrent City ot Everett Desi�n and Construction <br /> Slandards and Specilications. <br /> 3.Call�ocation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � s}L�' �(�L��[O.ai 4�vi� .s-�2CL� !il•���YJc2��'ii�L�i,liy � .�'� � <br /> .o�u-7'`-c.���.JL��. �y/ioov�D G���..�' " ..� c^,.G-_. ow ,5- � �-Y/. �`� <br /> �Cc3����.,�:c�C���. ^ � <br /> S iUn ia�,� ��t.fi� r/<«-.u�� s��,•Z s-if�fP[ 6e e-o�-�e-u/�,/I �/� <br /> �(na-cc��c./'ez�Jac�l,nfo 4�� .co,[.f/C�.�/ /�2. (IC,:.n� if`-tL�GO'� � ��� <br /> l�iJ-�1.'.CC��j G� Q,CC fCLCYq' L1-/ i�/lC�� �c�C,<J O <br /> J / � <br /> �. <(.CII� ,O��Lr'✓ C7%�4an<<� ltl�Tz/�= �,-�c<.i7` �[ 5��.�'� 6� �t'u�,� a <br /> ' � � •f� C. �07�2[<,C.C�ht, . <br /> �2 �. L crui a-��,/��.�t..mCi �-�.+-r.. , �� �,n�, <br /> --.1 ACKNOWLEDGEMENT OF CONDITIONS <br /> ' The undersigned ownedapplicant hereby ac�rees to hold and sav<_ harm� <br /> - less �he Ciry of Everett Irom any and all claims lor damage=. =osts. <br /> expenses, or causes of action thal may arise because of ins,. Ilr,ion <br /> l`�/ - /� �— �� �,/ and mainterance of the improvement or other right�ol-way use hereto <br /> �'���' applied br aad turther ayrees to remove same upen notice hom the <br /> Approved lor onstruc iD� � �d�e City and to repince public p�operty damaged thereby. <br /> . <br /> J v2 • � _ _ ! l �O� <br /> FINAL INSP ON Dale ' � <br /> Approved as Construcled Signature of Ap cant ate <br /> �Ar� PUBLIC WORKS DEPARTMENT WOflK AUTHOR ED BY THIS PERMI MUST BE STARTED WITHIN <br /> 3200CednrSlreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere��,WA 98201 BE DILIG[NTLY PUFSUED TO COMPI_ETION. THIS PERMIT Ml�Y BE <br /> Phone:259•8810 GINCELLED PV THE CITY UPON ANY STOPPAGE OF WORK ON THiS <br /> I PROJECT OVLR 90 DAYS DURATION. <br />