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� <br /> � �/ <br /> Date l' �'.' c5'9 �,����,�w�,�,�.,m,�. _8�-'_.._ <br /> Flino ocn� • ----- -� <br /> Applicat�on FOr <br /> PUBLIC WORKS PERMIT ``°°;�W�a��" s -- <br /> lcse Annl I.n Ve�a S <br /> oai���ao�� s /�l� rY�9�_GE <br /> Print or Type Ony� <br /> -STiaa lYlv�i�G, �ys :cnr,� 53 �� 1��rNc- �vc- 93zar 3.35�is's3 <br /> Owner Ma�linq AAdr�,s Gty 7ip Phone <br /> 4pphwnt MaihnU AAdii�ss Ciiy ZiP Phone -- <br /> /Y7ov�n�c, �SHS a�nr. ar- Tu� Re�rra�3 �'�Rr►� <br /> Descnbe Piopcsed Work � <br /> `� Tl � ���KC: R l o �a�i^ 'F y^ �/� <br /> �' t�.0 i,d« -_si`��C�r�T- /��� l�SF_�� » i,n/ r SA/ � <br /> ����,r n- !' T�' 7 <br /> ProieCt Addres5l�l knownl C �ZV— �vC�F� _ � <br /> Atlach fow 14I coD�es o�V�ans�Or DrOposetl wo�k� D�aw to scale and note Ihe lollowing Bs anPlicable�. � <br /> • Property Lmes • GeNerline ol ptreel � <br /> • Outline and Cia�ensions ol all eK�sting and • Indicate North <br /> proposed structures on the lot • Show any proposPd grading changes <br /> • �eisllng an0 proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITC BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AII cells lor inspection shell be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be pedormed in acCordance with this permit and current Ciry of Eveiett Design and ConsVuction <br /> S�andaras�nd Specilications. <br /> 3.Call Lor�tion UndergrounA Servlte 18 hrs.beiore you diy.TOLL FREE NUMBER�•8�f!-424�°5$5. � <br /> � <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigneA owner/apphcant he�eUy agrees to hold and save harm- <br /> �_ , �-�_ /� �� /S. ;ess the City ol Everett Irom any anC all claims br damages, costs. <br /> ����, /G/•� ezpenses. or ceuses o1 action that may arise because ol insta��afion <br /> //��L O / and maintenance of Ihe improvement or othe� righ�-of-way use heralo <br /> � ' -�t fJ?L9P7�L � �� applied lor and lunher ag�ees to remove seme uuon noUce Irom the <br /> Approved tor Conslr� tion �" Gty anA to reolace public property damaged thereby. <br /> —_ � � <br /> _ — /� �N `i/���� '� '22 <br /> FINAL INSPECTION ����e 7� Date <br /> Approved as Constructed Signatu� o:App6cant <br /> WORK AU7HONIZED BV THIS PERMIT MUST BE STARTI:'J WITHIN <br /> �verelt PUBI_IC WORKS DEPARTMENT 180 DAVS OF DATE PERMII IS ISSUED AND THEREAF'fEfi IS TO <br /> � 3200Ce0ar5treet gE DILIG[NTLY PU��SUED TO COMPLETION. THIS PERMiT M4Y BE <br /> Evereil.WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF�:'ORi<OM THIS <br /> Phone:2�9�8810 PROJEGT OVER 90 04VS DURATIGN. <br />