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__._--.__ <br /> Applica�ian For �". <br /> �� PtJBLIG WO�KS PERMIT Date ��-�3 - `/S <br /> c. <br /> PUBLIC NlORKS DEPARTMENT �,� Pubtic Works Permit N <br /> 3200 Cedar Streei Q <br /> Everett,WA 98201 259-8810 0 <br /> n Building Permit# ` .J 2 <br /> �::� <br /> o r <br /> TYPE OFi P'�INT ONLY i- i� v� � /��n <br /> Public Works Fee$ 7� <br /> CV -y � <br /> M iA yi a� U <br /> C':i,{✓ �t� lor SS�S We3t �-��s�'i''SS�: � e 0' Q,�.'. ��uuacj�,, Vlo 13 ' /✓5— <br /> Owner Mailing Address �•�Ci�? 2ip Phon Gcy (ory^_ �.y�,� <br /> L� , , l �/G'I G1J/K ,IY — i .S�n l / n i o � q�u5 <br /> Sfa�.s r> or��4 wc, y"'i,�c�s�a{b7e 9gt�/Z �3�0) 3�� - 7ao I <br /> Applicant � MailingAddress / City Zip Phone -yL J�,':S�j"',i <br /> Describe Proposed Work -�N 51t'a ll Fr �Jc r G�. C u��� %k ���/�/j� j�L c�4c'� _ � <br /> 7tir��u41.� ��. �. e ; �w au 24, l ro�.�� �2 ,til�t a�-�w4y /30�� �'��ss� 4 � <br /> C� � ,S7Yr �� s . —�4,C�c•sri ��- � jE�'—`'ST Lc.'� � �� <br /> �--- �, � lL f.�c% � ," M♦ <br /> PROJECT ADDRESS(if known) i{'oSS��i ^ � ?9T� �/E � 57��'.�1,�� <br /> Attach four(4)copies of plans for propused wo�k-Draw to scale and note ihe followinp if applicable: SCnt y�� � <br /> •PropeAy Lines •Dutline and dimensions of all existing and proposed siructures on the lot •Existing and proposed utilities � <br /> - •Centedine of sireet °Indicate North •Show any proposed grading changes •Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEAMIT CUNDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. � <br /> . 2. All c�ork shall be performed in accardance with this permit and current City of Everett Desiyn and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMSER 1-800-424-5555. � <br /> � L���C'liCa�7L /S /2"sy�-+[16C�' fc'i� ('c�-,PC/i:.�y i✓i/� V♦ <br /> ,S'/t'�ff #3- �J.3 /''',�'y[/i�c�len74.f� �/ t�7��nCr'MCh�` G7� � <br /> / 71 / <br /> Ql7f/ ��SfG�r6e0 G(./�ny`�qhC� C11"CQ.S . -�'C �/7c'rSjn�` � �is a <br /> / 1 , <br /> Cpn�1lDi� ��'��i« � �C�/�.7crt�� �d f/i�' CiY�/ ���/,�/li�✓ <br /> � /-� � � � / ( <br /> i'y¢ /[J/^ :sfi'[,i' 1/ly��'�J/�"'. <br /> / <br /> _� //!/J !`"I"M�T 1 � <br /> / CG✓=�'� .Sfi`�'_l �l�oS.Sin�1 �;/��/. <br /> �'- .�lC _Sf�^c�7` C��cssi�Js' �c � / <br /> 6Gf'CS C�n�7SS �c���rc ��:�/ <br /> � t/�e c:y /-1v6L�� c����Es' T.,s���t�n�� �r, ��'fi.ch ca s`� <br /> CGr�frotfi�v- ��-i�� Btc��'iCL l�:id/, C'Cr��- , � <br /> ��C<<��<,.<i�y f�r��{CC � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> , / /' The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> < :� %�L`�� ���jl� the City of Everett from any and all daims(or damages,costs,expenses,or <br /> �� Y causes of action ihal may arise because of inslallation and mainlenance of <br /> Appmvedfp onstruction ��e theimprovementorotherright-obwayuseheretoappliedforandfudheragrees <br /> _^ �� to remove same upon notice from ihe City and to replace public property <br /> �� ���l dama ed ihereby. <br /> FINAL INSPEC710N Date <br /> Approved as Consimcted � � ` <br /> ( . � /�L' (li �� l`. � ( C:r <br /> ighature of Applicant Date <br /> WORK AUTHOF�ZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON AN"STOPPAGE OF WORK ON THIS PRO.IECT OVER 90 DAYS DURATION. <br /> ' --- � -.. , ,,- <br /> , <br /> i,-� � ':,i- �: . <br /> .�fy,' - - .uy_. " <br /> �� ��., <br />