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oate,�y�nZ3�d'.�' �,,,������v,.,,,P�,m��, f/r,�/9�J�—�79_ <br /> APO�icalion Po� nini� nrN • _��I—f—L1�-IX..JGt-- <br /> PUBLIC W;DRKS PERMIT c�°°°W°,"«° — <br /> Totnl F�a S-- <br /> Lesf Appl Pee Paitl $!__. <br /> OTITIIf.CDYP. N �O� <br /> Print or Type Unly — <br /> J�'J�l� `��M� � [3nx 59�. La ,�o , ��P✓nYt� GBoZS� [oS 3 -e7/�o7S <br /> Owner �liny Atldress Ciry Zip Phone <br /> SR.�,� —_ -- <br /> Applicant Mailing Address City Zip Phone <br /> Desrrihe Proposed Work �� SvNG.Y/��Aww/�-�!� -- <br /> � <br /> _ _ -- W <br /> Prolect Address Id known) �'����--��F'E ���" � <br /> Atta�h'our(4� copies of plans to�proposed wo�k- Draw lo scale a�d note Ihe following ac apphcabie� � <br /> • Property,.ines • Genterline ut street � <br /> • O.itline 2nd dimensions ol all exisling anA • Indicate North <br /> proposed strur.lures on the lot • Show any proposed�rading changes <br /> • Existinq and p�oposed utilitres • Show measuremenl5 /�A <br /> �. W <br /> DO NOT WRI7 t °F W W THiS L W E O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in ativance•phone 259•89��. � <br /> p,qll worh shall be pertormed in accordance with ihis permi�and curren'City ol Everetl Design ar.d ConsVuclion <br /> Standartls and Specilications. <br /> 3.Call L ocation Underground Service 48 hrs.belore you di�.Tn!! �REE NUMBEH�-800•424•$555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> / �CKNOWLEDGEMENT OF CONDITIONS <br /> /]!�+' The�.indersiqnad owneNaPp��canl herohy agrees to��old antl save harm� <br /> �r less �he City ol Evere�t irom any and all claims lor damages, costs, <br /> i 1 oxpenses. or causes cl action that may arise because ol installatio� <br /> � � � o ir', maintenance ol the improveme��t or other righbol�way usc hereto <br /> Y.' �� '� / 08 , ilied lor antl further agrees to remove same upon noticc Irom 1he <br /> App:oved for Cons c i �a�z � �aud to repl�ce public property damaged thereby. <br /> ��G- G- = -�� � 3/.2 J/s � <br /> FINAL INSP-CTION Date .��J� �I �f� �� ° �� <br /> Approved as Consiructed Si�,�nature ol Appliwnt ��� <br /> WORK AUTI10RIZED BY THIS PERMIT MUS? BE STARTEf1 WlililN <br /> rvrrrr� PU9.ICWORKSDEPARTMENT 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTFR IS TO <br /> � 3200 Ceda�Street BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA F8201 C�P1::ELLED�Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona 25n�E1870 pROJEr,T OVER 90 DAYS DUR�ITION. <br />