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<br /> � �ut�bcWo�kSPnrmn• C�`��-
<br /> Date�� .. .�' .�� -----
<br /> � uing D�n��•
<br /> qpplicahr,R For
<br /> �r, _'—'—_ _ _
<br /> PUBLIC WORKS PERMIT °°°"""°""`° _
<br /> iotai Fee $—
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<br /> 'r�( Q � / �ty 2iP Phone
<br /> Owner MadinyAddrC�s_ -r
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<br /> �1�/LL/^/l /��l,,S� �. Phone ��
<br /> qpphcaM M�Jmc�Addres5 Cily Lp
<br /> Describe Proposed Work
<br /> 7•1�,li9/! �1�1 SFi /�/'J' F�'2' lOTS 2 /L�/03 — -
<br /> l'F Sif�+xT l's�T izs � ,��.v iw/ �-�i/ /5' ' uo'r�F
<br /> j�,� i� �c<< ��/ f7�'c,FSS �c'�'.4D c.✓ P,�i t .sri P ccs�.EizT�/ �
<br /> P�olecl Address I�I known) ��`'��% —� J�—�qG 1' S-r. — �
<br /> �
<br /> Attach lour 1�I copies o� Plans br proposed work � Draw to scale and nole Ihe tollowing as apPlicable-. �
<br /> • Prope��Y ��nes • Cenlerline nl street
<br /> • Outline antl Almensions ol all ex�sting anA • Indicate North
<br /> proposed stru�'ures on Ihe lot • Show any proposed gradin� changes
<br /> • Exisimg and proposed utildies • Show measurements M
<br /> W
<br /> s� DO NOT WRITE B[LOW THIS LWE O
<br /> PERMIT CONDITIONS �
<br /> 1.All calls lor inspection:;hall be r��ade 24 hrs.in advance-phone 2S9•88�0.
<br /> 2.All work shall be pedon�ad in aa:ordance with this permi�and current City of Everett Design and ConsVuction
<br /> Standards and Spec�lice;�ons, �
<br /> 3.Call Localion Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555.
<br /> 5/ L.C�rt.���.''<� `�8 ��D..c,v,�frF� //J fl.c/ffc« /`'Ei:' l'ii f/ O
<br /> .S'T-9.�'D9•cp i''G•C'� r.'T Ts/c Eivo nF T�/f E,riSTin/C,-
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<br /> E•U<.-.� ,�f LoT i 9 d6 C,Eon•�' LA�/E- V/
<br /> � Af,�uirzl� Ati� E�ASEir�E.�/T /�C.rcSs Tfl� �D�� i�'�,� °' O
<br /> Y�.2ePC,c'Ty ,—o /�'�,,�/ ,—fs� S,U�Sc'<<,�,�'s lc,,rs/��, li
<br /> /-, �/���f Lor SHSI« //�'v<' �A�,.�sFr'f'�FlrE Sioc s<<<iri:
<br /> /-irc/» Ti� N�eJ /'1.4ti�r/cic io Tj/E /!oc sE.
<br /> ���f/»ENi-�
<br /> 9��nTy��` �J�i��iG ldl�f'.�S ���<�'��T T���jb�r�rLEDGEMENT OF CONDITIONS
<br /> -. ryf s,-����r
<br /> ��7//L L �� ������~F'� �� The undersigned ownedapPlicant hereby agrees lo hold and save harm�
<br /> less the Gty o1 Everetl Irom 2ny and all claims for damac�es, costs.
<br /> / ezpenses, or causes ol action ihat may arise because o� inStallaUon
<br /> ,�--�(��/' /� ��3�� and mai•�tenancc of the improvemenl or other right-of-way use hereto
<br /> �:�JC.' � UTL`�ri":. apPlied for and lurther agrees to remove same upon notice iwm the
<br /> Appiov ��Conslructio� ^ � Dale City and to replace puUlic property damaged ihereby.
<br /> � .� �/ / -- ��� �
<br /> �/� i �� , , �
<br /> , _ Z� ,y-�,� - .1��
<br /> NAL INSFEG N % , ���� � � Date
<br /> qpproved as Constructed g nai���e oi nnni�ca�i
<br /> WORK AUTIiORIZEO B1yTHIS PERMIT MUST BE STARTED WITIiIN
<br /> everetl PUBLIC WORKS DEPARTMENT 180 DAYS OF DA1E PERMIT IS ISSUE� AND THEREAFTER IS TO
<br /> � 3200 Cedar Street BE DILIGENTLY PURSUED 10 COMPLETION. THIS PERMIT MAY BE
<br /> Everett,VJA 99201 CANC[LLED BY iHE CITY UPON ANY STOPPAGE OF WORk ON THIS
<br /> Phane-.259�8610 PROJECi OVER 9C DAYS DURATION.
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