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T� ^!1STI �— �'_ZC'I� r�ei��woner«�mn. <br /> `� ��/ <br /> ['B�P..---t��� NG _ _��3 I led �eo�� ql��J9 -- —. <br /> qp,lication Fo( -- <br /> pUgLIC VNORKS PERMIT '"°"`w°"„°° S <br /> TolalFn� <br /> Le55 A001 PC�PaN 5 ��' <br /> - Oaianccoue 5- ' <br /> Print or Type Only <br /> ��y Everett 98203 355-4725 <br /> � Lyle Blank PO Box 2266 Z;p Phone <br /> Mailing Atldress � City <br /> 9 �� Owner . . � � <br /> 4 <br /> K n Owner � �;iy Z�p Phone <br /> H xf — <br /> qpplicant Mailin9 Atldress <br /> '�tl H"�+J <br /> y~ new SFR <br /> ypr Dcscribe ProGosed Work <br /> � HC7 — <br /> H �g - - W <br /> �� � <br /> z y� — <1 Z i � i�iziz,�c.�= �� �� � <br /> Project Addiess 1�1 knowN � <br /> � �y � <br /> �y y Nlach four(•7)copies ol Plans lor pmposed wo�k-Draw to sca'e and note�Cc^`erline ol sheet able: <br /> �0,�7 y • property Lines • Indicate North <br /> ❑ • Outline antl dimensions ol all exisling unA � chOw any proposetl 9��tling Chan9es <br /> [q r pwposed siructures on Ihe lot � ghow measuremenis M <br /> � • Eaisting and proposed ulilities W <br /> � �N � DO NOT WRITE BELOW THIS LINE O <br /> �' PERMITCONDITIONS ^ <br /> 1.All calls lor inspec�ion shall be made 24 hrs.in adv-ance-phone 259•8810. <br /> � � 2.All work shall be peAormetl in accordance with thi; permit and current Ciry o�Everett Des�pn and Construction � <br /> I Standards and Sper.ilications. � <br /> I �� 3.Gall Locatinn Underground Service 40 hrs.6elore you d�g.TOLI FREE NUMBER 1•800•424•5555. <br /> � �_ �r,v-��va.�I �hr�l access a11�.1-viv�- �-�-✓'race O �� O <br /> I Y <br /> . �� r <br /> I �� � <br /> , <br /> �'= a <br /> I ' ' ' (,G�.i.OPJLEDGFMENi OP CJNDITIONS <br /> The undersigneu o�.neNapphcant hereby a9rees lo hold and save harm� <br /> ._�1 ���_ __ �--- less Ihe Gily c' � arett trom any and all claims for tlamages, cosls. <br /> ��. /� e>penses, ot cac:�:s ot action ihal may arisu betause ot installation <br /> ( J ,l ��� ` ' / _ f _ 7 �_ � and mainlen.� :e o� ihe improvemen! or othei ric�h4obway use herr.to <br /> � ��� � I � � �� appiied for a�•� furiher a9rees b rrmove saire upon notice Irom ihe <br /> 1 I O i. \ <br /> \��•�- Dale Cily and to rer�ace pubGc property�Jamaged Ihere y. <br /> Approved lor Construc�ion - / <br /> % � / <br /> �j r � <br /> ��;�/c :�— ! -/ 7. yz_ /� ��9 �r�2 <br /> Dale �` ' � ������� .--/� Dale <br /> FINAI INSPEGTION `.$,9 �1ute of ppli��a'. � <br /> ApprovedasConstructed WORK :U�HORIICi� BV THIS PERMIT MUST BE STARTED WIiHIN <br /> �Ar� PUOLICWORKSUEPARTMEN7 180 D.�S OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStrcet �E L'UGENi1.Y PURSU[D TO COtdPLETION. THIS PERM1IIT A4AY BE <br /> Evae16 W�`�8201 CANI�ELLED�Y THE CITY UPCM ANY STOPPAGE OF WORK ON THIS <br /> Phma 259�BB10 PRVJEC7 OVER 90 DAYS DURATION. <br />