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�� / ,/ FuUP.c 1Vo��s PCrmil• <br /> 84/=v L= <br /> /OY �—/—���— <br /> Date �� pl�q �cpt• _— <br /> qr ilication For <br /> Publl<WodeFee S J�� <br /> PUBLIC W��K� PERIVlIT Ta�a�Faa <br /> �e:snoo��FeaPa�a 5.�---- <br /> a 7G . C�__ <br /> ,lanco ouo <br /> Print or Type Only G90�s <br /> � ; '" C 4',.:. <br /> / �— , :. <br /> ' ` c� GG'� '� � Gc•�i i7 �(�;c �/ _�SS" / <br /> �1/C C[ S �°'/1;C 5 fN�- c�J �� .S(.�j��:�j;-C7/ �)lY� z�o Phone <br /> Owner <br /> Mailing Addresa <br /> C��(i'/UG� Ciry ZIp Phone <br /> Applicant Mailing Address <br /> :,K� a�' �nr= �'I'�c'r��d�,c�`''-f <br /> Describe ProPased Work �N S/ — <br /> ��_— • <br /> � <br /> -� P/�R Pr� ¢ �Un <br /> S' t,�7, Lcr //� , -ti'�FCE>uF t�T�IR: � <br /> Project Address(il known) _ � <br /> Fitach lour(4)copies ol plans lor proposeG work� Draw to scale and note lhe loliewin9 as applica6�c I_ <br /> • Centerline of stre?: V% <br /> • Property Lines • Indir.ate North ���;ng changes <br /> • Oulline and dime�sions of all existin9 anA � Show any Proposed 9 � <br /> proposed structures on the lot � Show measuremenis <br /> • Eaisting and proposed utilitics � <br /> CO NOT WRITE F3ELOW TI115 I.INE <br /> PERMIT CONDITIONS � <br /> 1. AII calls for inspection shall be made 2a hrs. in advance� pnone 259•881 5. <br /> 2. All work shall be pertormed in accordance with Ihis permit and current City of Everett Desic�n and ConsVuction � � <br /> Standards and Speciliwtions. -. <br /> r <br /> 3. Call Location Underground Serv�ce 48 hrs.before you di9.TOIL FR'�E NUMBER 1•800•424•55 . f <br /> � � <br /> N �. � <br /> O nr <br /> cc� <br /> iie r" r <br /> � '• <br /> f <br /> ,_� . <br /> FCKNO�h'LEDG[h1[NT OF CONDITIONS � F <br /> The undersigned ownerlapPlicaM herc by agrees to hold znd save cosis, <br /> less the Ciry oi EvereU Irom any and all ctaims lor damages, <br /> — —�Z� ezpens<s. o� causes ot �ction ihat may arise because of installatio� � � <br /> /" � ;�nd mainlenance o� the �mproveme�t or olher right-obway use herelo <br /> .� � �,. t� . : <br /> �-��!�f,,iw'-f� - z - o ap �� Ior ond further agrees to remo+° samc upon nolice f�om the � <br /> � Dal �iry and repL•�ce public �operry ageA thereby. <br /> p(Sioved Icr C slr � � <br /> i l '�� � V � � ,/I i_�/ �: ,. <br /> � r � � � <br /> (,�/,� _---C ��v;�.'/'2� -�- ''� ----p— c <br /> —�— ate licant .� � <br /> FINAL INSPECTIO Signatuie ot ApP <br /> qppwved as Consiructed WORK AUTHORIZED 8Y THIS PERMIT A1UST BE STARTED WITHIt: y r; <br /> G <br /> PUBLIG WO KS DEPARTMENT 1�0 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO F <br /> e��erett BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � 3200 Cedar Slreel - <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> phonc: 259'8615 <br /> PROJ[CT OVC-R 90 DAYS DURAiION. <br /> r <br />