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I <br /> � <br /> � C��U��r.Wa�MSPn�mit� J����� <br /> Date��� 6no oPo� • -- — � <br /> Application For _ _--- <br /> WORKS PERM T °„°'""°„�`"° s <br /> PUBLIC '°""P� <br /> Les•.nnni ca�Pa�n 5__�— <br /> � � ��' s --)if� <br /> e,i.,��„o�., <br /> r <br /> Print or Type Only � c�' ao �� <br /> ♦ M <br /> FbL�c 7575 �(- Wa qBZo► �fo8 �— <br /> �iG�H��nun �i i� iG � 7 n '' <br /> O�vnei Ul�nnn�, .�r.Jress o <br /> �� � �� O� <br /> c�Z�i/✓� --_ '"—_.S— —Lp ��_— Phon� — <br /> qpplicant <br /> — r.r.,�i���n ndd�css c�n <br /> Describe Pronosed Work ---- ----------�– <br /> '_—'—'— <br /> __—_— '.' <br /> ---3-zoo -1� k�iw,�L��-�---- - -- W <br /> Proiect�ddress I�t known` ���'w-G�e�—`�w G���� H <br /> � <br /> A�tach tour(4)eoP�es o� Ulans loi ProlwseJ wura � �iar to >rai�� ..ra nc±��mr�o��a.vmg ds anPhcable�. � <br /> • Property Lines • Cente�hnr, of sire!.• <br /> • Ircfif.ab_ 'Jvih <br /> • Outline and dimensiors ot all eais;ing ana � ����N,����, �:r000seA iJ�eding ch�nge5 <br /> , proposed structures on Ihe lot � ghow measuremrnta M <br /> • Existing and proposed utilities W <br /> � DO NOT\NRITE BELOW TNi�t WE O <br /> PERMIT CONDITIONS ^ <br /> 1.All cells for Inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.Ail work shall be performed in accordence with this permit end current City of Everett Desi9n and ConstrucNon r <br /> StanAards end S�ecilications. � <br /> 3.Celi Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800�424'.ri5 . <br /> �4• fEs Pr,►- •��jon� �°tzr, d�t� 7-l8�4�¢- O <br /> �" <br /> � <br /> � <br /> a <br /> �CKNOWLEOC� <br /> •ENT OF CONDITIONS ' <br /> �ih,,,�nda��ipnedmvneVaPP�i� � �^��tiYagreesloholdandsavehai.n- <br /> - --� -� --� —�-� iess the CitY �� �vereU fror r.y and all ctaims for tlama9es. costs. <br /> � ; �,nrnses or causes of aG�� ^ '���+� m�Y ���se because of instai�ation <br /> � �� �, ;�nd mau�iena��r.e nl the im, ���rement o� ��her righl-ol�way use heieln <br /> ', �� I ,i�.p�,ri lor and �urthor a9ree.., �o remove same upon notice from Ihe <br /> , D� , G!v ind to rePlaca:;uUhc proPe�ty damaged ihereby. <br /> A r ved for ,nsG� �. <br /> �� �U-�y. � II <br /> D�Ir Dale <br /> FINAL INSPECTION I S�qnatwe ot APphcan! <br /> qpproved as Constructed I �q�pqK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> FUBLICWOFI<SDEPARTMENT 790 DAYS OF Dl+TE PER691T IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street I BE DILIGENTLI' PURSU[D TO COMPLETION.THIS PERMIT MAY BE <br /> �/� Everett,WA98201 CANCELLtD BV THE CITY UPON HNY S70PPAGE OF WORK ON THIS <br /> Phone:259�8810 �i PROJEGT OVER 90 �AYS DURATION. � <br />