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� <br /> � <br /> � I <br /> ; ! <br /> I <br /> , <br /> , <br /> � <br /> 2-�-£�{ " -�= 7� <br /> Date " a�oi,�wa.e.ao,m�i. ��! -- <br /> ' APPlicatior�oi eina oea� • - <br /> � PUBLIC M/OR�S PERMIT ��°°��°W°��°F°a ------ <br /> to�niPec 5'- <br /> C2 <br /> � lessAnol FeePa�� S <br /> � 00 Balance0ur $ .���o <br /> Print or Type Only x o '� - <br /> � � � O��-��� -y�- -onn-i� _F3/ <br /> '` ;.; <br /> a «, <br /> �+s.) � r� ,�lA �Rll �l�l��`�1 l7� �Ji,2i�i 1' 9flZo� Z�-690� <br /> Owner MaJin�?Jdfy�� � Cdy Zip PhOne i <br /> � o i = <br /> S(l►M e- /q5 /}BOI/IZ to�+. a o c� � <br /> Appficant Mailing Address Cd)• Z�p Phone <br /> Describc Proposed Work �I Llr 1 u p��G� yy�u /�Il���ry A/��/.�0� yn� << � <br /> // W <br /> Proiect Addrrsslil knovm) 7��� U�'C�`� ��'�� � �� <br /> Attach four(4)copies of plans for proposed work- Draw lo scale ana nole Ihe following as applica�le: � �� <br /> • Property Lines • Centerline ol slreet /A ' <br /> • OuUine and dimensions ol all existing and • Indicale Nor�h V� �, <br /> proposed structures on ihe lot • Show any proposed grading changes , <br /> • Enistiny and pwposed utilities • Show measurements � I <br /> DO tJOT WRITE BELOW THIS LINE O <br /> PEPMIT CONDITIONS <br /> 1.All calls for inspection shall 6e matle 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accorrlance with ihis permit and current City of Everell Design and Consiruction <br /> Standa�ds and Specifica�ions. � <br /> 3.Cali Location Underground Service 4B hrs.before you dip.TOLL FREE NUMBER 1•800•424•5555. � <br /> �. /l.l� C•.' ��i �L. f>/�C i c� .=�i� ��::. '7 tC( .'�J ss� c.c�<- O <br /> ..C�r.�. _.�iZ.C: �CR-c�Gc:'a��/ �7!Qh� -U7-�Li.-CL. <br /> �/ i�/ l �� .�� <br /> j l-C�� .���u �C.I� ..Lo �L�O .!�'-«Cj�c'� Q: rLL�2CC P./(C 2�� ;c� � <br /> � �/� <br /> �Jir«Jf' �c. .f.r-�..�.�C.��U1� C��y�r��: /[.' �i -t �( N <br /> � �� ,� �� <br /> !Ot� �,'; _, /?Yt ( /.f: ,s � .';S"t . � <br /> a <br /> ��'ppp �CKNOWLEDGEMENT OF CONDITIONS <br /> �� Th�undersigned ownedapplicant hereby agrees to hold�nd save ham� <br /> less ihe City ol Everett Irom any and all claims tor damages. cosis. <br /> expenses, or causes ol action that may arise because of installnlion <br /> � . /� i �/.�..,� and maintenance ol Ihe improvement or other right-ol�way use hereto <br /> ` � � � ���' � �I'y- applied lor and lurther ac�rees to remove same upon notice I�om the <br /> Approved for Con pction �Date p��y and Io replace public property damaged thereby. <br /> �%�� `� I -//-d, � � /, <br /> FINAL INSPECTION Date � � <br /> Approved as Constructed Sig aWre ol Ap i a t Date <br /> WORK AUTHO ZED BY iHIS PERMIT MUST BE STARTED WITHIN <br /> everMt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE �� <br /> Everet6 WA99201 CANCELLFD B'P TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAYS DURATION. I <br /> II <br /> i <br />