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��,����:,o,�.,.�,��,� <br /> ��; — <br /> � �, - — — <br /> De�e-� /�i-`� eiae.oaoi.. S �f�.S7d ' — <br /> � Appl;cation For _ <br /> P 11BLIC WORKS PERMIT Puelic�YorksFea <br /> Tolai Feu 'S� <br /> Less Appl Foo Paitl $ <br /> e�ienoeouo s /f�'SlrO <br /> Print or Type Only 7�y.=� � <br /> w 3y�y— ��/�-;; <br /> P'-l/LlP L'S7EP /83/ �4ueKtR c9�F_ E�/ER�7 9��za/ N �52- `f9-18 <br /> � Mailing Address Ci�y Zip Phone <br /> Owner <br /> „� �(na r_ " -- <br /> Z <br /> Phone � <br /> Applicant Mailing�ddress ���Y Z�P –i <br /> C') <br /> Describe Proposed Work �u��� �2.J'�r_ W ��/ X 90 � PR•E FA'� m�r�� S�D G . m <br /> �� 3&3 % Pi4 /NE =-TRE� Ev��'F� �v�SN . � -;, <br /> � -� <br /> _ � �' _ <br /> 0 <br /> m <br /> c o <br /> .� `� '�/� S.T � m o <br /> G3�7� " <br /> Prolect Address(il known) 0 3 <br /> — m <br /> Altach lour(4) copies ol plans for proposed work- Draw lo scale and nole ihe lollowing as applicable: � _ � <br /> i Property Lines • Centerline ol street R� <br /> • Outline and dimensions ol all exisling and • Indicate North '–' <br /> • Show any proposed grading changes '� Z <br /> praposed struclures on the lot � <br /> • Existing and proposed utilities • Show measurements � � _ <br /> � � <br /> –i cn <br /> DO NOT WRITE BELOVJ THIS LINE � '� <br /> � <br /> O A <br /> PERMIT CONDI710N5 � 3 <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phnne 259•881 5. � –i r^ <br /> x <br /> 2. All work shall be performed in accordance with this permit and current City ot Everett Desiyn and Conetructien m ,,, <br /> U <br /> S'andards and Specifications. � o <br /> 3. Call Location Under�ro�nd Service 48 hrs. belore you dig.TOLI FREE NUMBER 1•800•424•5555. o r <br /> nm <br /> c v� <br /> 37i-�'ST. Td fjE f�.4✓E!� F.Zc�n� TNE WEST c.�c.�� Uf� 3iy'�.�i � zc'> <br /> `l /C //L� ` E^s r. �c? � LLV D E AND l2%T{/ .� •• �.�.'G.✓ES Gf� m <br /> % <br /> � D <br /> � � �• ^ A,�tiqtT, � S,t'E�CN A�r<a�LNE� � <br /> �;.,;-,�Acr�v CLas.. d � -� <br /> %C L�C <br /> 7r.�.�T^I t[E!J D <br /> _' (�A7.'!/d.e�//,� �(�,'J �.@Aiii.'GiNCJ � z <br /> � <br /> /��-,� �i;�:�,� .��t� ,. .. .-c ��. � z <br /> � <br /> � c <br /> —i <br /> f <br /> ('1 <br /> ACKF1011'LGDGEMENT OF CONDITIONS <br /> The undersi9ned ownedapphcant hereby ayrees to hold and 52ve harrm <br /> — less ihe City ol Everett from any and all claims for damages, costs. <br /> expenses. or causes d action lhst may arise because of installation <br /> '��� / � � � �`. and maintena�Ce of lhe improvemenl Or other fighl-o�-way use h0relo <br /> ,/ > baf�✓ ,/�/'I� applied tor and lurther agrees to remove same upon notice from the <br /> Approved for Gonstruciion Date q;y and to replac=. public property a aged therehy. <br /> —��/����� �= 3u-d-i'' ` ,1� .5 <br /> L INSPECTION Date Dat <br /> Approved as Constructed S� na re of Applicant � <br /> WOR UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> e��erett PUBLIC WORKS DEPARTMENT 1R0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PF.RMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE GTY UPON ANY STUPPAGE OF WORK ON THIS <br /> Phone: 259��&15 PROJEGT OVER 90 DAYS DURATtOIJ. <br /> . <br />