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1 � 1 id.xr IS.oH P�.rnrl•/� / [� — . <br /> �il�C'.—'/�J� tlinqDenl . �7./a�.l��- - <br /> / APPL[31iCn FO� � __ . _ _ _ <br /> PUBLIC WORKS PERMIT `'°°"""°„"`Ce <br /> ,���.�«� S-- <br /> i,,...nnni �,...r.,��i 5_ — <br /> , ,. ..�,., S <br /> Print or Type OnIV <br /> � _1', U,��,G� �zsa�a__l1�:�1�-c-��-- �_���� �'d'zoi <br /> �O!'ner `M:uliny AAdia55 l,dY Zip Phonc <br /> SL{�"/ �Cdy Zi�_� _� Fhone <br /> App�i�y�� Alailmg Addrrss <br /> Descr�be PropoSedlNork ���✓� �� )ILEel�4��—�`�'��{� <br /> -- - W <br /> Proiect A�tlress Id known) _ � --J�—J— � <br /> �� <br /> Attach�,our IQI �opies ol pians lor proposed work• Draw 10 scale anA note Ihe lollowmg as applicable � <br /> • Proverty Lmes • Centedl�e ol strect <br /> • Outlme and dimensions ot ail existing antl • Indiw�e North <br /> proposed slrucWres on ihe lot • Show any propOsed g�aAing changas <br /> • Ea�stmg and pr000s^d utdnies • Snow mcasurements M <br /> W <br /> DO NGT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance�phone 259•88�0. <br /> 2.All work shall Ge pertormed in accordance wilh this prrmd and wrtent City ol Everetl Desiyn and Consimction <br /> Standards and Specilications. � <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•8�•42p'S555. <br /> O <br /> l�(� �� ��I ? <� ;�/ �.� _/-� � <br /> ,{^�� V� <br /> j _ , - . ;- O <br /> � <br /> ACKNOWLEDG[M[NT OF CONDIiIONS <br /> 7h,�w�dcrsigned owneUaPplicant hereby aqre�s to hold and save harm� <br /> — ----- ie�:s the CAy o� Eaeretl Irom any and all clalms lor damages, cosls <br /> expenses. o� causes ol action that may anse because ol inslallation <br /> and mainlenance of 1he improvemnnt or other rigM-ol-way use here�o <br /> applmd lor and inrther �9ie�s to remove same uPon no�'ice ��om Ih� <br /> Approved for Consiruction Date Gty a��d to reP��a«���hhr p�oP<<�Y��+^1°9eC thereby <br /> FINAL INSPECTION Date ------— Dalr <br /> ApProved as Constructed Signature ol Appl�cnnt <br /> cv�rett PUBIIC WORKS DEPARTMFNT <br /> 80RD�YSTOF DA7E� PERMIT ISEISSUEDIAND THE E�f TER ISITO <br /> � 3200CedarStreet pE DILIG[NTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br /> EveretL WA 98201 CANC[LLED RY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT Ob'[F 90 DAYS D�H�TIOIJ. <br />