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, <br /> �—S t�] .. �' '" —Z�J"� v�m�cwon�vo•mn� � L�2L-- I <br /> Data--- "`L <br /> n�aa oeot.. 91�272 9 _ <br /> Appliwtion For <br /> PUBUC WORKS PERM�T °°°'""'°'""'°----- <br /> � !�jv ro���«. s <br /> ���' ���� TO POSTINf � � . aoo� �,.rPa�as _ <br /> Y H - o„a�o,o���. 5�-U _ <br /> ,o�x Print or TyPe Only 1 r ' I;; <br /> 9Hf~A ��� �� n ��. = � �' . ! �Jo� <br /> (�; i? r�. _. c-i .., -< � „- r i r'� <br /> r . u� .,i m m .� .� �n �„ ..i <br /> y �� Sharon 6owers :,r .: «+ .,. .n ri <br /> � n g�;1�d4};�10Yd4Xu� 6329 B.ever�'ry Lan� Everet� 11A 98203 347-0526 <br /> y`� Owner i� Mei�Ing,AAOres��� � �� �i�y,_.. Zip Phone . <br /> � M� r i � .' J —� ri [.h J Z �t r_1 <br /> �' c� � u � � r_i — rn _ tn <br /> � "l J J —I tl 1_ <br /> yy~ Owner �.�� '_- n .< <„ s � amot, <br /> Z ApPlicant r Maitinc�Atldress Gity Zip Phone <br /> � O� <br /> H <br /> H �g Oescribe Proposed VJork New SFR � <br /> G]• O ! <br /> 9 H� <br /> g �,y 54�U � <br /> H � <br /> � C� Prolect Address Iif known) XX lJ cr ri Ve H� i <br /> [�f <br /> [*1 Attach lour(4)copies ol plans lor pronosed work- Draw to scale and note ihe tollowing as applicable: � <br /> y0 y • Property Lines • CeMmline of street p^ <br /> • Outline and dimensions of all exisling and • Indicate North V� , <br /> proposed slructures on Ihe lot • Show any proposed grading chan9es ' <br /> • [xisting and prcoosed utilitics • Show mcasuremeNs /y� - <br /> DO NOT WRRE BELOW THIS UNE O j I <br /> PERMIT CONDIiIONS <br /> 1 <br /> 1.All calls br inspection shall 6e mzde 24 hrs.in zdvance�phone 2 5 9•8 8 1 0. � <br /> 2.All work shall be pedormed m actordanCe wilh this Uermil and current City of Ecerett Design and Consiruction <br /> �"' �+ Slandards and Specilicalions. ' <br /> � 3.Call Locaflon Undergmund Smv�c�•tF hrs.bMcrc you diq.TOLL FFEE NUMBEq 1•800-424•5555. � ' <br /> ..- �„„ O { <br /> � � , <br /> � <br /> �� � <br /> I`" " O <br /> _, a � <br /> �""� i <br /> � � ACKNOWL[DGEMEM OF COND11lONS � <br /> '� w ��� — 7 hc undersigned ownedapplicant hereby a9rees to hold and save hanm i <br /> .1� Icss Ihe Cily of Everett from any and all daims lor Aamages, cosls. <br /> ^ cxpenses, or causes ol actien that may arise because ol inslalla�ion <br /> , J � 1p ,�L '/_, �_I D .`,1 anA maintenancc ot Ihe imp�ovement or other right�ol�way use herelo '� <br /> _C(1�ii X � . r_us� ✓ �pplicd lo� anA Iwiher agrees to iemove same upon noticc Irom Ihr <br /> ApP�oved lor Cnn�:��� :lio� n��� Cily and lo replace pubhc rcnertv d�ged Ihereby. <br /> /' ' � <br /> .�� . � � � � � � � ��i � <br /> ,.,��, �� <br /> FlNAL INSPEC �"JN Date "'� � �� '�"�_� � I <br /> Approvetl as Co��s�ructetl iy ure ol A�P�icant �ale <br /> �7 PUBLICWORKSDEPARIMENT W�RK AUTH0�71ZE� BV THIS PERMIT MUSi BE STARTED WITHIN I � <br /> 180 DAYS OF DATE PER411T IS ISSUED AND THEREAFTER IS TO ; <br /> 3200CednrStreet BE DILIG[NTLV PURSUED TJ COMPLETION. THIS PERMIT MAV B[ <br /> Evereti,WA9B207 CANCELLED BY THL Ci'iY UPON�NY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 I PROJECT OV[f�90 DAYS DURA(ION. , � <br /> i <br />