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C�ate <br /> 6-15-90 �.. �J -3C>^ZQJ'S v,:rmwon�re,mi. � �$ / <br /> �i APPlicalion Fm TO p5T�N� eiao o.n�. 90/2486 <br /> PUE�LIC WORKS PEPF�M�1� � �' 1�� °°°.;:,�.°°° � - <br /> � �e.enno��a�v.�e5 _ <br /> Print or Type Only� � $� o�n � S� ,4�o mi���eo�e 5 �� <br /> p) �Y O�U�U O O O O P pl <br /> :: q !�i�T'O H W lu`-� � K P Y <br /> P W M W W el W F? <br /> � �� � « <br /> J3m Hoflin o'i�{� - B4 vr+ mnnf �1 oanll aaa-97'17 <br /> Owner � n� �x��rp,Wox�i w.+ ti u CnY Zip Phane <br /> �� �J �W J�� 020j � .�-1��-' <br /> QYI12L � J.�i] �i :� u]l�S =i S�i�i - �.� <br /> Ap0licant MailinqAddress City Zip Phone <br /> Describa Pmposetl Wark Nav dpylex <br /> � ZZ3Cl A 1-8 W <br /> P�o�ect Address�if known) � 19th A r c£ � <br /> Attac�lom�4)cepies of plans lor proposed work� Draw to scale and nole t�e lo�lowing as apnlicable: � <br /> • Property Lines •Cenledine ol sircel /A <br /> •Oulline and Gimensions of all e�isting antl • Intlicate North y� <br /> pmpaseE slruclures on Ihe lot • S�aw any proposed q�aain9 changes <br /> •Eeisling a�tl Oropose0 ulilities • SYow moasuremenls Y <br /> r� <br /> DO NOT WRITE BE�OW THIS LINE O <br /> PERMIT CONOITIONS <br /> 1.All calls lor inspection shall be ma�e 24�rs.ln ativanto-phone 259•88�0. ^ <br /> 2.All work s�all be peAormetl in accordance wilh Ihis permit antl wrrent City ol Everetl�esign and Consimction � <br /> Slantlartls antl Speciliceiions. <br /> 3.CaIILocationUnderBrounCService48hrr..beloreyoutlig.TO�LFNEENUM8ER1•800•424•5555. � <br /> q, �rcc�siorJ �oar�za� �.t�n�� � ��--mt.�.�.v� O <br /> �.s �rZ D� zcc_�ur� r,F �J��.ic wo��: <br /> �N 5 PtZ-TG2 . � <br /> V/ <br /> O <br /> a <br /> FCKNOWLEDGEMENT OF CONDITIONS <br /> The untler5igneA Owner/aOPLcaM hereby agrees lo hol�Bnd Sdv2 ha�m� <br /> less Ihe Cdy of Evere�t Imm any ana ail claims br tlamages. cosls. <br /> n,, �., (� ���� exven�es. or causes ol ac�ion I�al may arise because oi inslallation <br /> r / IAA antl maintenance ol Ine�mprovement or olher riq�POFway use hereto <br /> r� <br /> "�_t M1 apP�ied ior an0 luet�er a9ree5 to remove same upon notice Imm Ihe <br /> ApprOve On5�NC1i0n '�J �j� Oale City anE to�plato public proper�y tldm geC I�Cr py. <br /> /�/p7 �/ � ' � <br /> i AL /��c�,CxpLe2�/��l_.�pa1e � /� <br /> Appmve0 as ConslmcteC S' ature ol a.pplicam / Date <br /> eve�ell PUBLIC WORNS DEPAATMENT OPK AUTHORIZED BY TH�B ERMIT MUST PE STARTED WITHIN <br /> � 3200CetlarStreul 180 DAYS OF DATE PERIy11 IS ISSUEO AND THEREAfTER IS TO <br /> Everett WF9B[01 BE�ILIGENiIV PURSUEIYTO COMPLETION.THIS PERlAIT MAV BE <br /> Phone:255�8810 CANCELLEG BV THE CITV UPON ANY$TOPPAGE OF WOFK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />