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Date��1'. ' _ _\ r,��,,.,.w�,�a��.,m�. /�2�� � <br /> f :,.� '�_'• I ' <br /> Applicalion Fo� \� �� (`l� � I �l� ni�ip Deoi � -'_—'_ __ <br /> PUBLIt: WORKS �E MI'� I LJ pu�i�cWnaelee <br /> l.� ro„�r�. S— <br /> ��T 3 01992 �eaa�uoi F�e Pma S _ <br /> Baien<eDue S T �/= �CI�Q <br /> Print or Type Only ......... .... ... ..............._ _ <br /> CIT1' OF EVEREIT �(.( —ySG �� <br /> �uildlnc� �ivision — <br /> TH �" �'n�r,r/6 Gli Jc9O �nr :;'IO), /�� t of -7C- ,.5���/1'L�'— �'✓� `����% <br /> Owner Mailing AAtlrr,ss ity ' Zlp Phonc <br /> �.Y..-. t� (�-:'+ Ot,, ,�G�n.. <br /> ApPlicunt Meiling Address Ciry Zip Phone <br /> Describe Proposed Work �� ����� �a��k ���� �'rT �–r�'����'N.S/ d n� <br /> Project Address�if known) ��3 � �/9.1�/it/O .f-'.O � <br /> J./ . � <br /> Atlach lour(4)copies ol pinns for proposed woik� D�aw to�calr,,nd note the lollowing as app iceble: � <br /> • ProPerty Lines • Cenlertine ol slreet _ . -.-........". � <br /> • OuNine nnd dimansions ol ell exisimg and • Indicate Norih ��j ( ��,F EVERETT <br /> proposed slructures on Ihe lol • Show eny pronosed yi����prysCaUntCf <br /> • Existing end p�oposed utilities • Show meesuremenls � <br /> DO NOT WqITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inapection shell be made 24 hrs.in ndvance•phone 259-8810. � <br /> 2.All work ehall 6e pedormed In ecco�dance with this permit and current City ol EvereU Design antl Construc�iun <br /> Standards end Specificelions. <br /> 3.Call Loce�ion Underground Service 4B hrs.beloro you dig.TOLI FREE NUMBER 1��800-424•5555. � <br /> � l.��n�E ?0 6e ��e ��.-����h s �l���i���<�c�� oa /G'�v-9.�- O <br /> 6y ��r. £'��erc�,�v�c,2 �vo��� �/�f <br /> � ./�C !t//���/r e �n��/'ic7li/' /"�'..f��nY�-fin�') /7�C�.I,� �'E' C��7 P � <br /> �Jsr ffia `G� ffC�r' f� ✓��,� ld�•ls�i �i ': r� /r� -'l •/;S�Z � <br /> T/'GI�J /�L� i%�y ���ai'.;/.iv�v .!���di`,'i.�(i�7, O <br /> � l a <br /> �CHNOWLCDGFMf NT Of" CONDITIONS <br /> ihe�undnisi(�neA owner/qpPhc;mt hereby a9reP5 to holA nnd save hann- <br /> ---� - irss Ihe City ol Everett Irom any and all claims lor damopes, costs. <br /> � ) � rxpenses. or causes ol actlon ihal may anse because ol irtslnllatmn <br /> � '� --� j�� i�� And main�enance ol �he improvemenl or o�her rlgh��o�-woy usn hcreln <br /> <'_- .- � /0 �n 9� N�plieA for and furlher agrees to remove same upon notirc Irom the <br /> A p�oved e onstruClion� J , D le City nnd �o replace pubh property damaged the�aby. <br /> �� , . � � � �����j � � � / <br /> F AL I 5 ECTION � " � ' Date � � — /� �,l_y_�._-_ <br /> A�moved as Construcled IgnaWre of Applicant Datr� <br /> �� PUBLICWOiiKSDEPARTMENT WORK AUiHORIZED �Y THIS PERMIT MUST BE�. STARIED WI7FIIN <br /> 3200CeAerSt�eet 1H0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere1LN/A98201 [3F DIIJC,[NTLV Pl1RSUED TO COMPLFTION. THI$ p[RMIT MAY C�C <br /> Pnone.259�8�10 ��,��NCCLI I D HYTH� CI7V UPON ANV;TOI'P.AG[nF WORK ON TI�iIS <br /> I�'Hl1Jf(7 OA'LH '10 DAYS DUMIION <br />