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Hxn � <br /> M � <br /> � � x <br /> � �� Date �ii 3l �C��� � ��,�,��:�•:.,..�..,m(,���., ������//�q`3�}- �-" <br /> ��3 �'L F-1 / r I C� ��1,:S � rL amo oco� •.L"l_c""'.'-�� <br /> ApplmaUon Far <br /> ��� PUB�.I'i, WORKS PERMIT 10 `��a� °°^;�;,��a`°° s _ <br /> m H �,.,,���,� �,., ;.,., s _ <br /> , <� — <br /> H <br /> t,� �:, .., ,,,.. s .- <br /> '�`�H t7 Prinl or TyPe Only T� �n�T�IYG _._ . — --- - - — <br /> ON �y <br /> H [�+10 � - � _ �/ ./1 <br /> HVn � l F (. ll� � ` _S�/�i� .S•J G� - <br /> q �5P—/�o� N ��nc �}— Si3� �/r�6� � 1 � ,. a:oy,_--:—L-�— � <br /> �H ,3, Owner hlaJinc�Adtlress Ci�q � �-�P ��'����' <br /> H [�1 <br /> �.��� HH <br /> y �hi <br /> H APPlicant tA.ulinq Addresc Ctl)' ZiP Phono _�—.— _' <br /> C] t7 fA <br /> ��r / r J � <br /> Z H V Describc Proposetl Work /� a i SiA� (H 71y�ui�� ��1 Ll.��f— 7 <br /> HOcn <br /> _ — � <br /> Proiec�Address lil knownl 4��"� 1 ST 1��.. S� � <br /> Nlach four(4)copies of plans lor prop�setl worle- Draw to scale and note Ihe lollowing as applicable: �� <br /> • Properry Lines • Centedine ol sirecl /^ <br /> • Outline anA dimensions of all existing anA • Indicaie Norih �� <br /> proposed stiuctures on Ihe lot • Show any proposetl 9rnUmg rhnnnes <br /> • E.isting and proposed u�ililies • SF,o�v measurements �/� <br /> W <br /> DO NOT 1NNIT[ E3LLOW THIS LIN[ O <br /> i� ' PERMITCONDITIONS <br /> � 1.All Cal�s for inspec�ion shall b^made 23 hrs.in ativance-phone 259•881Q ^ <br /> � 2.All work shall be pedormed in accordance wi�h lhis permit and curtent Ci1y ol Everetl Desi9n and Con;tnicUon ♦ <br /> � Standards and Specifications. <br /> I ' 3.Call Lowtion Under9round Service dB hrs.Uelo�e you di9.TOLL FREE NUMBER 1•800•424-5555. � <br /> i '�_ <br /> � I 9 .ANl' CHANGE ]N THL' DRIVGWAY Cf�'P MURT IIl�, APPRtIVI?[? O <br /> 11Y THF. PURL�C WORKS TNSPECTON. <br /> 5.CONt]rCT DOWNSPOUTS TO POBLIC Dr�A7NAGP SYS'PEM. � <br /> i ��..w., 6.ii13EE' CITY STRF.ATS CLE�N AT AI�L TIMES. � <br /> 7."NY DAMAGE 7'O THR CUF�3 AND SIDEWALK WiI�L ER RfiPATR'�.I? <br /> 'i'J 'I'HE BATISI�ACTIOW OF 'CHR PUeI,TC WORKS DFPT. � <br /> �I_i a <br /> __ <br /> ACKNOWLGOGFMENT OI-CONUITIJNS <br /> �i, ,����� The undersigncd owner/apP�icant hereby agrees la holtl antl,avo hmnr <br /> -ro�— i Ir,ss ihu Cdy ol Everett irom any and all clai:ns for tlamages. costs. <br /> � expenses. or causes of aclion Ihat may anse because ol install�hon <br /> ��' anA maintenance ol the improvement or o�her ughl�ol-way use. heiela <br /> �-C-,�Q.r� `LCc�. Co -'L9-`.�O <br /> applied lor and furiher ,c�rees to remove same upon no�ice Irom Ihe <br /> Approved for�onsiruction j Date City and lo�eplace puUlic ioperry dama�eA Inereby. <br /> _= � �.�i%% . � ��., . . .:;r/ � ' 1 . . � r �. � <br /> FINALINSPECTION Date ' � � _ / "�� � / '� '� �� - <br /> qpproved as Constructed Si�n lure oi AnPlica ���� <br /> WO K AUTHORIZED BV TF 3 PERMIT MUST BE STARTE� WITHiN <br /> i����p�( PUBLICWORKSDEPARTMENT 100 DAVS OF DATE PEF' f IS ISSUEU f.ND THEPEAFTEf7 I510 <br /> � 3200CedarSheet BE DILIGENTLY PURSUP t0 COMPLEiIUN. THIS PEf7Gtli hL1v (3[ <br /> Everett,WA9d201 CANCELLED BV THE CI i � UPON ANY STOPPAGC OP WORK ON ti1IS <br /> Pnone:259�8610 PROJ[CT OVEF7 90 U�VS DiJfL1TION. <br />