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� <br /> �-Zc -29� 9� �8 - � <br /> r��o��cwo,ksPa�m��, — <br /> Date�l3W�1 .. ome oao� •�1J2691Q <br /> Application For <br /> ^� f�E R M I T Publi[WorFs Foa S <br /> ' W O R KS r°�T�FA� - <br />, PUB:�I(. <br /> S �essa�ni �eeva,n 5 <br /> � TO POSTING_-3/.,,��_- 5 ��- <br /> y C' �J � ... , �•.. o.,�.,�c„o��� <br /> n f n rJ -� n p r-� r <br /> t J [. C.� L. '� � <br /> p � � Print or lype Only � ` � ll � � '� ; <br /> :� U rJ � �i u] i .. <br /> n ^P ..� 252-�511 <br /> 9 H G� � °' i_c� 11 Lombar3 Bverett 98201 <br /> H � ,�, AI�dEYSen� Victox s aames � - , Y Zi Phont <br /> y H O�Nner o' � �i Mailig.A��essti �� u� , C�t P <br /> �' �i t9 t� CC :/_ =S O ".1 C� bJ .-� L1 <br />' �C C] ? onw �.� m � c i- oarw <br />. H "� j o _i � w � c anwr, x _ _ <br /> Otrmel5 -. a� o_ z :L � sc. � xx m -. c� Phore <br />� City Z'� <br /> � N M qpplicant ~ Mailiny Adclress <br />�, Ox <br /> p� Construct neH� duplex - — <br /> y Describe Proposed Work <br /> C7 <br />� ��g -- W <br /> H <br /> I � y � 32 32 d.xg ` <br />� �..i y - 26th St r <br />� l7 f/�� Projeci Address(if known) �� <br /> n�y AUach lour(4)copies of plans lor pwPosed work� Draw to scale and notc ihe following as appiicable: � <br />�� O Gentedine of sireet <br /> • Properry Lines • Indicate Norih <br />� y � • Outline and dimensions of all eaisting and � Show any proposed grading chan9es <br /> y� y pmposed structures an the Io1 � ghow measurements M <br />�� • Existing and p�oposed uiilities `�� <br />�I DO NOT WRITE BELOW THIS LWE O <br /> i <br />� � PERMITCONDITIONS � <br />,� `��� t.A�l calls lor inspeciion sh211 he made?.4 hrs.in advance�phone 259•8810. <br /> I � �� 2.l,II work shall be pedormed in accordance with this permit and current City ol Everet�Design and Consiruction <br />( Standards and Specilications. � <br /> 3.C:all Location Underground Ser�ice 48 hrs.betore you dig.TOLL FREE NUMBER 1•S00•424•5555. <br /> �{. /_crnecE. dc�vnS���S f� s�k.ed.a.ns -�o s;de sewe.- � <br /> I �� J�. �"na-�� �1m��� -G'.)m'cr..GnF'�� �tn. S'hc�t,���Pa-�' �2�"Z' 2/' `/D <br /> �����-� � <br /> I �_�= O <br /> a <br /> , ,-, — <br /> P.CKNOWLCDGEMENT OF CONDITIONS <br /> �1 ' �' /J Q.� The undersigned owner/applicanl heret�y a9�ees to hold and save harn� <br /> ��w less ihe Ciry of Everett Irom any and all claims lor damages, costs. <br /> � - expenses, or causes ol action that may arise because of installalion <br /> and maintenance of thc improvement or other righ4ol-wnY use hereto <br /> 1� 0 w A L�_ r�� �9� applied lor and further ac�rees lo remove szsve upo� notice (�om the <br /> � «'�'�� � � Date Cily and to replace ubliy.property dama9ed thereby. <br /> Approved for ConslrucUon j /� <br /> [/ � � <br /> _i�•�'�.'�� .. ._-� .�'� � L-- '��� ( � �j - � 1 Date <br /> Date <br /> FINAL INSPECTION Signalure ol Applicanl <br /> ApprovedasConstructed WORK AUTHOP.IZED BY THIS PERMIT MUST BE ST4RTED WI7HIN <br /> �� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> 'rr� 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.�fHIS PERMIT MAY BE <br /> Everett.WA 90201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DUFiATION. <br />