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Date I �� Q� Tp pOSTING 'In-� P°�6cWorMSPermu• //'� �� <br />C'�9.00PL � _9n�� <br />Application For <br />PUBLIC WORKS PERMIT PuoTolalFeeF�� S <br />- LeS: ApO�- Fae PaiE S <br />D <br />' � i r-. r: ,;� ;., ;_, -: BaianceDue S �Q�- <br />Print or Type Only - " � ' `': ' ' ' � � � <br />c. r,� rJ G��. r� Ci �.-] ;- <br />��i n �� n�� �� � .. �,�. <br />.� i, . .� .. . <br />V��inre �7r��►'l1p/� 5602'-,�f'Oc�e���'Ceri; .�5.3_755.3 <br />Owner Mailin9 A(Idress���i Ady Zip Phone <br />1:.. Ci r!t !7 ^_ La: _Y C, lil r_l 4t l � <br />��, �� i. r.i C, fn _ : I�J <br />r.' fl ..i ._! Til i: C� 1�1 C:� 01 - <br />h') ._ �.l i�. .. .-. f°. :T bl �e :f� r �' <br />C:l <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Prolecl 4ddress (if known) <br />Attach lour �4) copies of plans for proposed work <br />• Property Lines <br />• Outline and dimensions of all existin <br />proposed slructures on lhe lot <br />• Exis�ing and proposed utilities <br />PERMIT CONDITIONS <br />t. All calls for inspeclion shall be made <br />2. All work shall'-� pertormed in accor <br />Standards and Specifications. <br />3. Call Location Underground Service <br />5� %Gr+��o0�'a r j! re L <br />hat Ge wifl,:�� <br />-�----�-►.1_l - <br />ol� <br />FINAL 1 <br />Approved as Gonstructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 CedarStreet <br />Everett, WA 98201 <br />phone:259�8810 <br />�� <br />� <br />whyme?�SIZ�IyZ <br />i-i�fC.�\ � <br />�� 5���� � <br />� �/�',�./ <br />�.� S . <br />rars o wnuwa swe..s�.i.,uc <br />enoc.�5 � <br />y e�-- z z <br />p b <br />�� <br />� <br />O <br />�w <br />—/ <br />O <br />a <br />�_,�..,_ <br />�..,,_. <br />u,nu„ <br />here�o <br />om Ihe <br />Signature ol Applic n v Datc <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STf.RTED �NITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />