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J <br /> �' /�/`�I/ f�uo�m Wo�he Pe�m�l• ��,��'u_:i - <br /> � 39�s — <br /> Date � r BIOp UeD� • <br /> Aqa�i�:auon For — <br /> P�J(� fiK� PERMlT P�o,,�wo,.,F�o _ <br /> �I���' \��O lohiFee S___' <br /> �r �vaaeooivicean�es---L90 -- <br /> � <br /> Br�ence Due s L�--. — <br /> Print or Type OnIY �'��� <br /> / ,., .Z��t-iT y¢1a/ 3 S"5--�/�iZ <br /> l�til} /J�d?E-� �v[_ ,S'�G _< <!�t?�P•TT/�1fki. !U/ 7 Phone <br /> Owner <br /> Maih,�g Address Cdy Zip <br /> �CC�1CJ� _ Ciry 2ip Phone <br /> Appli[nnt Malling Address <br /> .U'TAtC. .3 5�!U,��f IGYGt'/�1'�-r �7R i✓r.`a//4�_--- <br /> Descr�bo Proposed Work � ✓ <br /> - - W <br /> i UC�'iKEn�� �=SrRTz.� — 70i- I�Fa�i Ew/E (�/ft f�_ � � <br /> Pwject Address(it known) ��` � <br /> �s <br /> Attech lour(4)copies ol plans for proposeA work� Oraw�o scale and note the lollowing as aF?hcable-. � <br /> • Property Lines • CenterLne ri slieel <br /> • Inaicate North <br /> • Oulline and dimensions ol all eaisting and � Show any propes��d y�aA�ng chanyes <br /> proposed siru:tures on the lot � Show measuremenls M <br /> • E:isting end proposed u�ilities W <br /> DO NOT WRITE BEIOW TH13 LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall Ue mada 24 hrs in advance� phone 259•881 5. <br /> 2. All work shall be perlormed in accordance with this permit and curren�Cny ol Everett �esi9n and Construction � <br /> Standards and Specil�cations. � �- <br /> 3. Call Location Undeigrowid Servlce 4N hrs. belore you di9.�JLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> � .. <br /> H � � <br /> � n <br /> V dF <br /> � � <br /> � � � <br /> � ' � <br /> :a � <br /> r <br /> r <br /> �Ch:NOWL[DGEIdENT OF���OND��i iJNS �', v_ <br /> Thc undc�sirined owneqappllcanl hereby agrees to hold and save harm� <br /> F <br /> less the Ciry of Everett Irom any and all claims lor dama9es, costs. O 4 <br /> � eapenses, o� �auses of actlon that may arise because o� installation <br /> �' antl maintenance ol the imp�ovemeM or oiher nghl�obx�ay use herr.to 'T1 r <br /> �' .. �• � applied for and luriher agrees to remo�e same upon nohce ��om the � G- <br /> ����� / Datc ��.y� eplace publ' pmPerry tlamaged ihereoy. <br /> Appf ve Io�C�clructlan , <br /> � � � ,� ��� �,_ � � � �- ����y � f; <br /> ;s r., �- � � <br /> � Date Date �' <br /> FWAL INSPE�TION Sign9�t re ol ApplicaAt � � ; <br /> i.ppwved as Constructe yyppK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI`HIN r <br /> 180 DAYS OF DATE PEfiM1T IS ISSUED >ND THEREA�TER IS TO [; <br /> everett �UBLIC WORKS D-PARTMEN r• <br /> � 3200 Cetlar Str�el BE DILIGENTLY PURSUED TO CO��PL@ti��N. THIS PEF'AIT MAY BE <br /> Evercli.WA 98?01 Ci�NCELLE�BV THF CITY UFON ANV STOPPAGF OF WORK ON THIS <br /> Fhone: 25J-80'�5 FROJBCT OV[R 50 UA1'S DURATION. <br />