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:.R�IIi..y.��. `_—_.. _.. . .____ <br />, _ <br /> T� nnSTING '2�3A� � 3s1 <br /> pubLc Wo�ks Parmil+ <br /> � Bidq.Depi.� __—��� <br />� Date — <br /> .� <br /> AoplicationFor i P��hii�yya�xsFee <br /> RKS PE�M�T '°'a""e 5--- <br /> PUBLIC WO tL LessAOD� FeePaia $�- <br /> � s�-- <br /> �. � Ba�ance Duc <br /> J <br /> �: <br /> C �� <br /> Only = ':' " <br /> : Print or Type ;� :* ;N � !�Z SS-sc— <br /> A r..� � J <br /> �w'" `� r�'`C� � ' Phone <br /> r: `-isc-T <br /> i _, Cr,y, <br /> tvlaifina AC ress � �I � N <br /> Owner � �' � �'" _. <br /> �-/ �/ G� ce <br /> �—� T( ��T � t, �' ' u• ZiP Phone <br /> � , N I V 1 �`Cr � ____----� CAY <br /> .. �. �Lrd�AAdr�55 � <br /> ��. " qpplicant (y���_ <br /> .� s� �; ������ �� � - <br /> � �� ��r 6��� _ <br /> �i' Describe Propased Work ���� � <br /> � �s - -- �-- _ ___ -- -- W <br /> --__---- ----_- _-- i- <br /> -------- _ <br /> Project Address(it knownl ------ � <br /> �. � Drav: to ;ca1:e and ncte U�e toiluwing as aDPlicahie: <br /> Attach four(4) copies oi Plans fo� P�oV�»��__ <br /> • (;enterline of s;reet <br /> • Intlieale North <br /> � Property Lines � <br /> � �how any Fropose�l9ratlin9 changes <br /> • OuUine and dimensions o� ali exishng and � ghow measurements <br /> proposed structures on the lot <br /> • Existing and proposed ulilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> � x'� � pERMl7 CONDITIONS � <br /> . 1.All calls for fnspection shall be made 24 hrs.in advance-Phone 259•881 O• � <br /> 2.All work shal�be performed in accordance with this permit and current City of Everelt Design and Construction <br /> � Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•S00'424•5555. <br /> O <br /> � <br /> � <br /> I,; ,' ` O <br /> � a - <br /> ACKNOWLE�GEMENT OF CONDITIONS ' <br /> licant hereby a9rees to hold and ses. costs. �, <br /> // 7he under=igned owneVaPP �d all claims for damag . <br /> D`. --- -----'� Iess the Ciry ot Everett Irom any a a�iso because of installation <br /> (` gxpenses. 0� GauSes o� aGtion ihat may <br /> i <br /> O�� � i ��i�f maintenance o! lhe improvement or o�her right•of-way use here o <br /> ��pi�„d �or nd turther agree �° ��amaged herebyn notice f��m the <br /> ale � C�!y nrd to e PubliC Pro Y <br /> q roved�f JConslru tion , /J// t i 1 <br /> �/! Da��a�Z�Cit/ �� ✓�!nT I Date <br /> �� ��f Dafe I <br /> Si9���we o�qpp icant <br /> FINAL INSPECTIOtv' y,/ORK AU�HO ZED BY THIS PERMIT MUST BTHEREAFTER ISHTO <br /> qpproved as Constructed <br /> 1A0 DAYS O DATE PERMIT IS ISSUED A <br /> p�gLIC WORKS DEPARTMENT gE DILIGEN LY PURSUED TO GOMPLETION.THIS PERMIT MAY BE <br /> � 3?00 Cedar Streat I GANCF.ILED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Everett,WA98201 PRO.�EGT OVER 90 DAYS DURATiON. <br /> Phone:259-8810 ! <br />