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T-i-LS- � � <br /> DateSZl13L41 "' ( Q wen�wo,�.:c�,m�i. :I�ZZCc ___ <br /> TO POSfIP1V_ � —��--11 Bia90ept• 91/2�13Fi _ <br /> qpplication Fa <br /> ti C']H -� — <br /> �;y PU��LIC WORK� PEFlMIT Pmi�cV;o�ksica <br /> ,o�a�FA� §— <br /> ,o z z �:_ «,s a��� �,�F, S ------ <br /> c H ; - — <br /> �. <br /> 9 H V1 � , r. � r, [._ Da v,.�n.� '_ _—'— <br /> �' Print or TyPe Only �'' � � " ` ' ' ` <br /> �-37-�H c.i �� � :' oi �rri '� �,or r � .�� <br /> w r i ❑� � rl 1-1 �� <br /> ' " M .... wi (1 <br /> � y� � ;r . r �r ._u t� .V <br /> � H� Patrick & I.inda O'hgil 1439 ywssuth Ave Everett 98203 353-6922 __ <br /> tY�H Owner °' ��`��_� � q:n���SS�''i «: �-+ � :- CitY ZiP Phone <br /> y z C' �� r� c ri'T��'' c i i i � i, �3 <br /> y � �'] LJ r.] � O � ' O i � [� tJ <br /> \ u J I I 1 I c 'i t G W . ]. <br /> � y� OIJRCL I_ ' tii . u '.i � K 3 .:Y. Gi-.' _J __ <br /> p H Mailinc�Address Cily Zip Phone <br /> � �� Applican� <br /> G]M C' <br /> g Describe u�caosed Work _�4RStXuct new S�_ <br /> > H:�f � -- --- <br /> t" I�H <br /> g `n _ — �.1.9 <br /> �i <br /> o d cn l 4� <br /> � �t" XxXx Kossuth A.ie _ � <br /> 7, y� Proi��ct Address(if known) _ <br /> y �� Att:;oh four 14)cop�es ol plans W� proposetl work-Draw to scale an]note Ihe lolloviin9 as applicable: � <br /> f� Properry Lines • Cen(edine ol street � <br /> a Outline and d�mensions ol all existing and • Indicate North <br /> proposed s�ructures on�he lo� • Show any pruposetl grading changes <br /> � Exisling and proposed utili�ies i Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> Q� �'! PERMITCONDITIONS <br /> '�'' ^'� 1.All calls lor inspection shall be made 24 hrs.in advsnce-p�one 259•881 O. � <br /> 2.All work shall be pedormed in eccordance with this permit and current City ol Everett Design and Construction <br /> S�anda�ds and Speciflcations. <br /> ,`� "' 3.Call Locclian Undergrountl Service 4S hrs.bcfo�e you Cig.TOLL FREE NUMBER 1•800•424-5555. � <br /> x, ,,,I <br /> � <br /> ' . ,�. � <br /> 1 v♦ <br /> � <br /> .� � <br /> !'� ACIWOWLEDGEINENTOFCONDIPOIIS <br /> The underslgned owner/applicant here6y ao;ees to hold�+na sove hann- <br /> less ihe Cily ol Everet� I:om any and all ciaims for Uam.gos. costs. <br /> �--' 6 �'1�� � oxpenses, or causes ol actioo �hai m�y 6nse Uecause of inslall[,lion <br /> � � � �.'/- �_1 �_91 and mainlunance of the improvemenc or other ri9hi�of�way use hereto <br /> .1��. .. V �_r.ti.� � lied lor and furiher agrees to rer��e same upon no�ice trom ihc <br /> ^��c- PU <br /> Approved 'Conslruc��on ���e City and to replace publir.proPPrty tlamageA ihereby. <br /> �!.c�"����� �� l3 � ,—, � ,�„� 7 i� '�- <br /> PINAL INSFECTION - a e — ' <br /> qpproved as Constructed Sigwture ol Applicanl Date <br /> WORK AUTHORIZED BY THIS PERMI7 MUST BE 3iPRTED �✓ITHIN <br /> PUBLICWORHSDEPART�dENT 180 DAYS OF DATE PEflM!T IS ISSUED AND THEREArTE9 IS TO <br /> �`�� 3200CedarSlrcel BE DILIGENTLY PURSUED TO f,0A1PLLTlOII THIS PEf;L1!1 hi^,Y OE <br /> l- Evem�l,WA 98?0� CANCELLED BY THE GITV UPON l�NY STOPPn���OF lVJ9��('-f<1HIS' <br /> pp�,��r ^'S')-9R10 PF7(t.II.QT OV[H 9� DAV; DURi.11ll.'J <br /> � _ <br />