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_ � <br /> r <br /> '1 <br /> '1 <br /> r <br /> �3 � <br /> puoim wmxs Pe�m��3 <br /> d1� 83 6 <br /> Dace 5 e�aa oeo� • ° <br /> qpplicnlion For -- . <br /> U� <br /> PERMIT PubLCWoiASFce S -�_�__ <br /> PUBLIC WORKS '°'°"`° <br /> � los��oD�Pon Fe�a 5 �O� <br /> Balance oue , <br /> G3� � <br /> Print or Type Only <br /> / ��iN, � YS �.7c <br /> � r i ` V�C:e.xJ �—s� <br /> .f STP L�PT / �%'/N /"i—'�'=r. t.:�.ti� .xN. 2iP Phone <br /> ,��� Giry <br /> /!.N Mailinfl A r! '�a':ti''� �6��J <br /> Owner C,/ C/J,1 <br /> �j; <br /> OHLf /3 ,G.✓t c%: i fi // c`��t ZiP Phone <br /> C ��'���'� `���Sy`Y � MailingAddress Gity <br /> l�pplitanl <br /> �-"�� r� "< <br /> �(� �G �.n � � f-1.. 0 .� <br /> Descrihe Proposed Work <br /> W <br /> � O8 S �,�. s:E. I— <br /> � <br /> Pmject Address(it known) � <br /> Ntach four(4)cop�es oi plans tor Proposed work-Draw to scale and note�Ce��,e line ol stree�ablo: <br /> • Property Lines • Indicate Nar1h <br /> • OuUine and dimensions of all eaisling and � Shoµ,o�y proposed flrading cl anges � <br /> proposed strucWres on the lot � Show measurements <br /> • Existing and proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT GONDITIONS ♦ <br /> 1, All calls for inspeclion shal�be m.de 24 hrs.ir.ad�ance� Phone 259•88I5. <br /> p, qll worh shall be Pertormed in accordance wilh ihis permlt a�d current Cily ol Everett Desgn and Cone«<���ion � <br /> Standards and Specilicntions <br /> 3. Call Location Underground Service 48 hrs.�ebra you di9.TOi L FREE NUMBER 1•/800•424•555 • O <br /> � � c;.r��- � ��� c..�UCI /IP✓J <br /> �,,,�.,�� /a ' C�.,�. <br /> �rnrnaSt �7' �n ���. <br /> ��, �� ���r .. �.. <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF COeD;o�oo a nd save harm� <br /> Theu.idersi9nedowner/apPlicantherebyag r.osts. <br /> less ihe City o� Everett Irom any and all claims b� damages, <br /> / andemamtenanceVolsthe mproveroe t or olher b9hPoi waY�Seahe�eto <br /> �,/( l{Uf� S .3i �fj <br /> � Date Cityl1and�o ep ace`publ cflp�opertyrdamaged tFherebyn nolice from the <br /> L AP�y,� on91r clion � �� � <br /> ' %�71�,� —� G <br /> �,� �fi%l. � • /' . <br /> ,(r Date <br /> - Date �9�a�urc o��P ic�anl <br /> FINAL I SPECTION � <br /> ppprovedasConstructed yyORK AUTHO IZED BY TNIS PERMIT MUST BE STARTEL` WITHI <br /> PUBLIC WORKS DEPARTMEN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> evcrett BE DILIGENTI.Y PURSUED TO COMPLETIOPI.THIS PERMIT MAY BE <br /> 0 3200 Cednr Streel C�NCELLED OY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br /> L Everett,WA 98207 <br /> Phone:259�BB75 i PROJECT OVER 90 D�YS DURATIO . <br /> L �. <br />