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Date� �`� , <br /> 11:-, .U� ��.�.,���,.,,.,��<.,�,��. -�-- — <br /> � Q � ! o�.�, o�w . C1_J����1L/- --- <br /> ', PPpl�za��on ror j <br /> a <br /> p '� � P�JBLIC WORKS PERMIT c��°4o,;.���°° $ <br /> �y ., <br /> [ H tn <br /> � � X Lesa AaD�Feo Pa�a 5 <br /> y ir o.,ia�<oo�� 5 <br /> K y � Print or Type Only <br /> �°c .°1. ro 7�5-/?(c`� <br /> N �� � -�c�,sie��.ls.r � �3 /l ,Sl��r,�� ti r-,P� ,�� � :S zu 5 ��b'CJ7G�s <br /> O H Owner Maihng Atldress Cily Zfp Phone <br /> � � n <br /> � � ����4 <br /> �,�,'� y ApPlicant A7ailin�Address Ciry Z�p Phone <br /> M <br /> N H n � �) <br /> Gy DescribeProposedWork !,'�Li��� 1�'LC�' fPYI�('iC4A� S�����,��lYit����(IiH�1 <br /> 0y° ro <br /> O y <br /> N <br /> � � ( � W <br /> c�rnjr�Adtlrnssliiknown! 7.d..(��JJ11.7���I/Q � <br /> l,ita:.'��'ocr�11 :'oeies ol plans for O��Posed work-D�aw lo scale antl note Ihe lollowing as apP�icablr. �� <br /> f �'i�perry Lines • Centedine ol sVeet /.A <br /> • ��:O:ne and dimensions ol all existing and • Indicate North V� <br /> . �osed stmclures on Ihe lot • Show any proposed gradin�changes <br /> 0 E> sting and proposed utililies • Show measuremenis /�/� <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> P[RMIT CONDITIONS <br /> i"�� ���'�\ L All calls lor inspection shall be made 24 hrs.in advan^e�phone 259•881 O. � <br /> C�" 2 All work shall Ue pedormed in acwrdance with this permit and current Ciry ot Everetl Design and Constiuction <br /> Standards and Specilic�iions. <br /> - 3.Call Location Underground Sern[e 4B hrs.before you diq.TOLL FFEE NUMBER 1•800•424•5555. � <br /> 1 <br /> I '__ O <br /> � /l <br /> , �'� ���j'"�/C !!'!:/ ,( s /r^. . ...�/ /.�s�'� /'�_��� ,.:�r(, <br /> /';� � �— <br /> i �,,.. � i� —�—;°;� � <br /> 0 <br /> ��,�I a <br /> �1 �� ACKNOWLLDGEI.tENTOFCONDITIONS <br /> The undersi9ned owner/applicant hcreby agre»s to hold and save harm- <br /> � ' less �he Cily ol Everetl from any and all claii�s lor damages. costs. <br /> I�' eapenses, or causes ol action ihot m�y arise because of installation <br /> and maintennnec of the improvement or other nqh`�of�way uso heieto <br /> t�1� applied lar and �uriher agrees b remove same uVa� notice Irom ihe <br /> Approved tor Conslrur.tion 0��� City and to replace puUlic property damagi�d Ihmeby. <br /> FINAL iNSPECTION ���"- � - <br /> ApProved as ConsVuc�ed Sic�na�ure of Applican! �ate <br /> �� PUBLIC WORKSDEPARTMENT WORK AUTHORIZED �Y THIS PERMIT MUST 8[ STARTED WITHIN <br /> id0 JAYS OF DATE PEI7MIT IS ISSU[D AND THEREAFTER IS TO <br /> � J2CJCedarStreet BE DI'_IGENTLY PURSU[0 TO COMPLETION. THIS PEi7M1T MAY BE <br /> ��� Everetl WA 98201 CANCFLLflD BV THE CITV UPON ANV STOPPAGE OF WORK ON TH!S <br /> Phone:259�8810 PIiOJECT OVER 90 DAVS DUFATION. <br />