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� � � <br /> m � x <br /> C, H <br /> � xHCa <br /> HZH <br /> 1� C] <br /> r ;q , <br /> � H '��J � ` ,��42. <br /> C/J H '—�—�I F�m�cvx+r:Pcenna __.. — <br /> y Date_—_ � � <br /> C'1 O � APPlicalion For ti�.o9.oao�.a .91��,� __ <br /> � " ��y P�JBLIC V!/ORK� PERMIT P°°'°`°°"°'°� 5 -- <br /> H [��] O ,o,�i F9�. -- <br /> �� � � LessAoW.FeePr,¢f 5 __ <br /> , ; qz <br /> i'� P�sCTIN� _�I�-�— a.�9�«o�a s i0— <br /> > y � Prin` or Type Only --- <br /> t•� z <br /> Hy <br /> � <br /> c� d vH, i-_'17Z LL?�� t1e)MES IZ4k�- �{O'ri-1 AV-""e � �vT `3�s7�1 �-�7 1� <br /> � � � Owner Mailing Addres� City Zip �'hone <br /> HOC�n 1 -- <br /> �,pphcam. Mailinc�Address City Zip 'none <br /> Describe Pioposed Work c�0�'LY2l�C'�_.�`��?��S�I�L!-\-C t�AAM��` 1�6MC <br /> — - — � <br /> Project Address(il knowni G� " 4 L� �,rt S� S� — � <br /> Attach lour(4�copies of plans for pronosed work- Dr,v-to si.ale and note lhe tollowing as appl'cable: �� <br /> • Property Lines • Centerline of 5tre�t � <br /> • Ou!line and dimensions of all cxisting and f -,dica!e North <br /> proposed slructures on lhe lot • Show any proposed grading changes <br /> 'm' • Existing and proposed utilities • Show measuremenls I�A <br /> YYr <br /> 1 ' �O N97 W�ITE BELOW THIS LINE � <br /> 0 <br /> PERMITCONDITIONS OB/2E/°? ��:B'�" CO ,iEc � <br /> ��� 1.All calls lor inspeotion shall be made 24 hrs.in advance-phone 259•SSl O. % � <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Fverett Desi�}��p�ti�,f�'op;lructipn <br /> ' ' Standards and Specilications. P' � � a7'6 �5 <br /> � 3.Call Loce;ion Underground S�rvice 48 hrs.betore you dig.TOLL FREE NUMBER 1•$00-����-5555.���:7Q � <br /> t <br /> �� �1. 1�lL�ST i�/�vL n��,vtw�1 ��c�i�'� P��'' �--���� � <br /> cc� a+..,o <br /> �� `�� C C��C�� C�r� 1'��lC t^,L�1 1 � N � t�io`�uy8��.�D <br /> —) seaE� �so.uo � <br /> s v.7i-s r�i.�.o� ♦A <br /> 1_ 4L'00073?t �/� <br /> � :b50.OQ ` <br /> WRTEi � <br /> � ' CH'cCii 'O4'FS,SS <br /> �� 1� <br /> �� <br /> �' <br /> � I�11p ACKNOWLEDGEMENT OF CON�ITIONS <br /> � ^"," The undersigned owner/applicant hereby a�rees to hold and save harm- <br /> �7. - less the Cily of [vcrelt Irom any and all claims lor tlamaycs, costs. <br /> expenses, or causes o! action that may arise becouse ot ir+stallaticn <br /> nn �-, q� and mnintenanc2 of ih^ improvement or olher ;iqht-ol�v+ay �se nereto <br /> �(u u � `' `� �U' �` 1 J :,pplied lor and lurther agrees to remove same rpon notice irum the <br /> Approved���Consl�ru�r�lP�' / �a�e and r ace pub!ic prop�rty damaged tl�,�eby. <br /> /� i' � <br /> /�ii��fl�, � %rv -i t � y � ! <br /> -i. — — ` O ��W <br /> FINAIINSPfCCTION Date � — -- <br /> Approved 3s Consirucled :i9natrr;;of { �l+ nt Date <br /> WORK AUfHORIZED BY THIS PERtv11T MUST OF STA TED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUEG AND iHEREAFTER IS TO <br /> 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. fHIS PERMIT MAY BE <br /> Evcrett,WA9b201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAYS DURATION. <br />