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.� <br /> P„�,��,.,�„_�,.,�„� . �s 46s , <br /> Date.�=q s � <br /> �ia9 Deol . <br /> / <br /> qpplicatiqn For _._— <br /> PUBLIC WORKS PERMIT °"''t��v�F�e`�° 5 <br /> Less4nt�IfepPavlS ////'�y/� _�O, <br /> Balancc Duc 5—i—�— <br /> Print or Type Only BP <br /> E � L ��)eu-! o � Po �� �-r7g �v��.���- w A Ggzc� 3 4g- �a3�- <br /> 1 or t,dy 7_�p Phone <br /> Owner \�atliny 1r,dress , .. <br /> Nom�s��l AI�1c.�'nr.�l=t��s Po �i;� `lSbS `Ever�i��8Zo1____�_�'$(�3 <br /> qpplicant Pd:��unq Addiess' <br /> Cit�� ZiP Phone <br /> m 5����_��'S�P__��OY0. C� <br /> �qc t----- Scx� ds_f3_l�__o�• <br /> Descri6e Proposed N1ork —�-J' - � <br /> � � ��_��o►�=-_--s������cb_o+ s ��-- <br /> r� w. o �s <br /> _ ------- ----------- W <br /> 'I i � y_'i_13�H9,n��_r___Qr�ve� — - � <br /> Prolect Address lit known; - _ <br /> Attach four(41 copies of Plans lo� P«Pused wo:K � Orav: ta sc,�l^ .u,a noh� th��'o�lowin9 as anVhcab�e. � <br /> • property Lines • Cian�erline ��1 street <br /> • Indicatc Norlh <br /> • Outline and dimensions ot all exisLng and � �i����, ,�ny r.roposed��radmg chanaes <br /> proposed structures on the lot � Show maasurements M <br /> • EwSling and proposed ulilities W <br /> DO NOT WRITE 6[_OW THIS LINE O <br /> PERMIT CONDITIONS � <br /> t,All calls tor inspection shall be made 24 hrs.in advance•phone 259•881 O. <br /> 2.All work shall be performed in accordance with this permit and currenl City of Fverett Des�gn and Construction <br /> Standards and Specitications. � <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ¢ r7���J L�/�y .Sf/-".,�.�S G���n r7� � L� t.�»es O <br /> S ���"Ov c�� �raS�C� CL'ny`rv � QS O�irC•f��c� � <br /> ,�y �/�,� Ci�f/ �c-6L�� G�orti:r p'�sf����'vr /A <br /> V/ <br /> O <br /> a <br /> ACKNON'LEDGE�dENT OF CONDITIONS <br /> lh..�;^d„���ani�d nwneVnPP�icznt heiehy a9rces to hOld and sace harnr <br /> - -�-- --- --i ies:. ;h�-� Cny o� Eveiell Irom any antl all claims lor Aama9c`;. ;.osts <br /> �,� ecpense;. oi wuses o� action that may anse because nl msiauatwn <br /> C� and mainlenance o! tne impro�ement or other nghPoFway �.ise hereto <br /> �/%� / �� �'ji 1i,n,: Ior and luriher an�ees to remove samc upon notice irom Ihe <br /> AP rbved�o� uction ate � ^,��.�nct tn i��n��ce ib�c , nertY J ed Ihereby. <br /> - �'-z�-s7 _ I h�, ` G Eo n s' <br /> "�,, — <br /> FINAL INSPECTIO �`�fe I t <br /> Si<nalwe o�APPIiCan! <br /> Approved as Constructed �q�ORK AUTHORIZED BY THIS PERMIT �1U5T BE STARTED WITHIN <br /> �� PUBLICWORKSDEPARTMENT tA0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �f0 <br /> 3200 Cedar Slreet I BE DILIG[NTL\' PURSUED TO COMPLETION. THIS PERMIT tdAV B� <br /> Everett,WA 98201 , C4NCELLEU P'!THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 � PROJECT OVER 90 DAYS DURATION. <br />