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C <br /> . . ... . _ ._ ._ _ . ' .. ._ . .. . __... __ _._ __ _.. . _ .. . ._ . ...__ _ _ . . . _. _ . _ _ . . _ . _. <br /> IDate j—�-95 -� ' Z•�— ZJ� � PuOL<WoiMSPermn• ��� �� I <br /> p B�a9 oeot. «ins}, I <br /> I AppliCation For Tn� pSTING o �Z I <br /> PUBLIC WORKS PE-:R�IT P°°��°W°,k,F°° I <br /> Toiri Fee s <br /> Less ROCL Fce PaiO s I <br /> � - . B�ia�ce�ue S Z� � <br /> � Print or Type Onry , `, �', ;:-: ; � <br /> I _ L L I <br /> l �: � I <br /> I " . ' - ' ' .. � 'a <br /> � Arut.� c:onst i�205 13i�t'.: i;t. f:irkl.�ldV�J8034 821-475i5�� e °+ <br /> IOwner Mailing Atldress - City`� i � v, r„'�, Lp . Phone I <br /> I � _� - �^ -,- i i -. � <br /> ,ir_ r , t � :.i <br /> �� Owner Dal��� i.l���d � '� :� ` � � I <br /> Applicant Mailinq Address Ci�y Zip Phone <br /> I <br /> Describe Proposed Work _ ���'�� '"U:"' <br /> � If31Z ?r�Avc.SE Lof / W <br /> ProieU Address lil knownl 'H3�8--3rd�lvr YE ;4�t—:; Sh��rC Pl�C If6-9� � <br /> Attach four(4)copies oi plans for proposed work• Draw to scale and nole Ihe following as applicable: � � <br /> • Property Lines • Centerline ot sireet � <br /> � • Outline and dimensions of all existing and • Indica�e Norih <br /> proposed structures on ihe lot • Show any proposed graAing changes <br /> _ • Existing and proposed utilities • Show measurements � I <br /> DO NOT WRITE BELOW THIS LINE O I <br /> PERMIT CONDITIONS <br /> 1.All ca�ls tor inspectfon shall be made 24 hrs.in advance•phone 259•8810. � I <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitications. I <br /> 3.Cell Locetion Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � I <br /> I. 2colio�� �r�i�u�c^ sh�J( be iii�cL.�r�;:�d. � <br /> ;i 1 I'o the sde's •tonn dr:.m sy::u•m (p�'i��atr ur publict � <br /> b�j 1 u u re���de•hti:il tuoi duivnn��o��i y�Sh�m de�+ipli��d E�oi scr�im� !�=� I ol .6�r � i <br /> cily sttmdnrdi; � i <br /> c) Oute �pl��el� Mocl�e <br /> lhe method �elec�t��d�ti�il) I�a sub_ject to 1'ui�iic 14ork6 D:}>�111:'(�i;�rt :t4��ii'u�+t! � I <br /> �. Dr�ve�vt�y mual i��. �,:ic�aJ �ruv� prup:i9� .u�� li� edgr ol alra:�t ��ocwnr�d. <br /> O <br /> I <br /> a . <br /> � <br /> ; <br /> i ACKNOWLEDGEMENT OF CONDITIONS '� <br /> , .r.��� %��/%� The undersi9ned ow�er/applicaM hereby agrees�o hold and save harm� �'I <br /> ' � less ihe Ciry of Everetl Irom any and all claims for darages, cosis, <br /> .' . � expenses, or causes ot aclion ihat may arise because cf installation I <br /> ' � / ������ �. �/� /�/- and maintenance ot Ihe imU���ement or other right-ol-wr.y use hcretc I <br /> � applied lor and luriher agrers to remove same upon n�tice fron �he i <br /> iApproved lor siruction � Cily and to replace public prope�ty damaged ihereby. , <br /> � � \ <br /> I il ._ �- Z7 � ,�,� -.�'� >..� t:� Y-:� - ���_ ' <br /> IFINAL INSPECTION Date — <br /> Approved as ConsUucted Signa�e ol ApPlicaM �J �sle <br /> I WORK AUTHORIZEC BV THIS F� •� � MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERNIT I� �.�. JED AND THEREAFTER IS TO ' <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO (. '�+^LETION. THIS PEFMIT MAY BE � <br /> � Everett,WA 98201 CANCELLED BY TH`c CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I plione'259�BB70 PROJECT 01'ER 90 DAYS DURATION. � <br />