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� � ro <br /> io s Date ��„����.wo�.�r�,m,�. _�� z�J�1_ <br /> y � y o��fa D�oi • _—' <br /> � � � Ap^�icahon For _ <br /> y " PUBLIC V110RK5 PEF�MIT ''°°'°�°�"„`° ' � <br /> K y � iotni iee S '` � <br /> O 's O <br /> b �y ,� �ese nooi�ec ra�e S�._ <br /> N I-i '� / <br /> y� � �n Haiancc Ouc $�5.�{_ '�S C <br /> � Prin� or Type Only <br /> r� <br /> °z i o <br /> � � R �,` �� ��r�'SeLr ���,%_S �9 L�'rG(�� rr?C ���r/u�� l�-�(re y :�f- z ;' � <br /> q y � Owner MaiNng AtldreSs City Z�P PM1onc <br /> r� z <br /> H N <br /> N <br /> N <br /> � � r AppliLani Mailing Addres5 City Zip Phnnc <br /> Z H N ^ /� 9 / / <br /> y � � Describe Praposed Work / Vf[�! t r, /JQ 1� Q� �� c!' J ��e �jii/7� li.���'�('lC�C(S E- <br /> /' W <br /> Prolect Atldress lil known) � a U � 1 3��� . V �C �i.' N �.� . __ � <br /> 111ach�ovr 141�.opies el plans tor prOposed work� Draw b scalr and note the lollowin�as anPlicable�. � <br /> • P�oneny Lines • CenleNine of sireet /� <br /> • O�tline and dimensions of all existing antl • Indicate Nor�h V� <br /> p�oposetl 5irucWres on Ihe lot • Show any proposed gia0iny changes <br /> • [xislmg and proP�sed utditic; • Show meesuremenls /y� <br /> W <br /> /���� DO NOT WRITE BELOW THIS LINE <br /> I �� PERMITCONDITIONS O <br /> 1 1 All calls lor inspection 5hall 6e made 24 hrs in ativance-phone 2$9•88�0 �\ <br /> 2.All woik shall be pedormed in accordance wilh tiiis permd and curren�Ci1y of Evere�t Design and Consimction ♦ <br /> �� Stand2rds and Soecifications. <br /> == 3.Call Lowtion Untlergmund Service 48 hrs.belore you tlig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �LY c��7 r �^-r,�� .C�-S �/c� '� IZ f,��� �Z- O <br /> � � <br /> e.� � <br /> O <br /> � <br /> 1�' <br /> �'_' - — ACKNOIVLEDG[MENT OF CONOITIONS <br /> ' 7he undersic�ned ownenapplicant heieLy�9rees to hold and save harm- <br /> less Ihe City ol Everett Irom any anA all claims for damayes. costs. <br /> ����j- , I expenses. or causes ol action that may arise because o� installalion <br /> � and maintenance ol the improvement or oiher nghl�ol�wa�' use hereto <br /> ' � - � Z— applieA tor and Iurlher ag�ees to remove same upon notice Irom ihe <br /> lq�proved "r Con uction � � , Dale Cily and t reUl��e pub6c propertY damaged thereby. <br /> . i <br /> " � �' �-�- v�` !��� 'C'���� � � ._ <br /> iL �� i-� � <br /> FINA I PE O ` ' Da�c <br /> Ppproved as Consiructed Signatwe of App iwnl � Date <br /> ���@/ PUBLICWORKSDEPARTMENT WORK AUTHORIZED BV THIS PER IT MUST BE STARTED WITHIN <br /> '� 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> L �E DILIGENTLY Pl1RSUE-D TO COMPLETION THIS PERMIT �dAY BE <br /> Evere�t.WA 9820� CANCELLED�V THE CITY UPON ANV 5TOPPAG[OF WORK OIJ THIS <br /> Phone�.259�8�10 I=ROJ[GT OV[f7 00 DAYS OUR%.110N <br />