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� �� + , <br /> � ; ��,.��,.:�,.,,,..� �. <br /> =f�_�=�, <br /> � � oate '�%�'- - - _ <br /> y men oeo� • <br /> KJ :U C qpplicalion For _. <br /> � y y PUBLIC WORKS PERMIT P���rwo��eFae <br /> tmal Fee 5 <br /> H � � �esaPpO�Poe PaiO S "" <br /> K n <br /> o y o �,,, ,.�„ s _ <br /> �9 n � Print or Type Only <br /> � � � ./ <br /> `�`S"2"-�s'o J <br /> o � ��N c�l � �g3 , ��/ a,�- , ��,�� � ��>�� <br /> %7 f1 o�i (� ¢�'YY✓e D /� / Phone <br /> N `� n Owner Mailing A dress �ty Z�p <br /> j��u:.�; <br /> � � � �a A �/� iss , ��//� ,o� E.-�r�' �r��, oasl-�sov <br /> O m Modinc�A dress Cily Z p Pho c L-�;y � � <br /> �y A icant <br /> Roy <br /> � � ro ,� ,�� � <<u �����o ��u� 1 �-- <br /> Descrihe Proposed Work / — r n� <br /> � O m � " � � a< �CL1.l�dJ_ <br /> Ta' / 'i C • { <br /> �- � <br /> Proiccl Address lil known) 3 y�� 4-'3 yvH ��i��-+ E�a� �Af� ���e/ � <br /> �v <br /> Altach fow�4)�opies of plans lor pmposed wo�k� Draw to sc�le and nnte Ihe lollowing as appticable: � <br /> • Properly Lines • Centerline ol street <br /> • O�tline and dime�sions ol all exisling and e Indicate NOAh <br /> proposed structure5 on Ihe lot • Show any proposeA 9radin�Chanyes <br /> • Existin9 and proposed uhldies • Show measuremenls /� <br /> W <br /> DO NOT WRITE BELOW TIiIS LINE � <br /> /�_ <br /> PERMIT CONDITIONS � <br /> I '�� 1.All calls�ot inspeCtion shall be mad0 24 hr5.in advanCe�phone ZSJ•SS�O. <br /> 2.AII work shall be peAormed in utcordance with ihis parmii and current Giq�oi Everett Design and Consiruction <br /> 1 SlandarAs and Spec�tications. � <br /> — 3.Call Localion Undere�rountl Servico 48 hrs.hetore you dig.TOLL FREE NUMBER 1•SOO•424•5555. <br /> s /� <br /> _�' � ` � �' S .�-('-��n..) C1 ( �� '�-� �/ <br /> I , K��� c. , � -t-� s-�.re� -� �_ I <br /> ' ` /"- � �.-� `J I � � "' � <br /> � Ic� � clea� <br /> i �� � <br /> ��� O <br /> � <br /> � f ,�� <br /> ACKNOWLHDGEMENT OF CONDITIONS <br /> ' i he undcrsiyned owner/applicant hereby a9rees Io hold�nd save h:..rm� <br /> �' t_1 _ ' Iess lhr. Ciry ol Everett Irom any and all claims for dama9es. costs. <br /> � eapenses, or wuses o� aclioo Ihal may anse because ol inslallalion <br /> and mainlenance ol the improvement or o�her ri9hPol�way use herclo <br /> � applied �or and lurlher agrees lo remove same upon notice Irom tha <br /> D'ate Cil anA to replace Ublic pwper�y d�9etl th reUy. <br /> Appr v d tor Consiructio/ 1' ) J <br /> �J/y!�_�___� ji. 2 - 'i L /j��r�j�>l� - � �L�I�i,'1��:�- <br /> FINAL INSPECTION Dalc p�T <br /> Approvetl as Constmcted ic�n�l of p �licant <br /> WORK AUTHORIZED B� THIS PER611T MUST BF. STARTED WITHIN <br /> PUBLICWORKSDEPAR7t.1ENT 1F70 ��YS OF D�TE PERMIT IS ISSUED AN� THEREAFTER IS TO <br /> �� 3200CedarSireet BE DILIGENTLY PURSUED TO COM1IPLFTiON. THIS PEfi1d17 AtAY BE <br /> Everetl.W/+9B201 CANCELLED�V THE GTY UPON ANY SIOPP�G[OF\VORh ON THIS <br /> Phonr�'w9�8610 PROJ[CT OVGfi 90 DAYS OURATION. <br />