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I � <br /> �J.3- �s/�Sy�[ <br /> �afe � �� Pu�l¢WorkS Pe�m�l�s _�f,L� �� � � <br /> A�plication For e'°g npp1�`� '—�/�+--� � , <br /> Pl.6 �LIC ir'VO�KS PE�,��J� I�' Put�Ta��FeeFec S -- II <br /> Less AOVI Fce P�iu S_ 'i <br /> Print or Type Gnly ea�,�.<eo�� S __ ; <br /> , <br /> �_�'�'�-=�� ` � �_��� "�/`)� - � 'l ' � ��� �?Fa 1S I <br /> Owner Mailing Address C.ty ' Zip Phone ' <br /> � �'a3�5 � <br /> Applicant Maliny Addrees Citl' Zip Phone � <br /> � cy , �`�'L�� �� <br /> Desciibe Proposed Work �f ��� � �� t � 'i <br /> Projecl Address�if known) /Q�QZ — ��— �/�LS f" � �� <br /> � <br /> Attach f wr(4) copies of plans lor proposed work� Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ot sireel � <br /> � Outline and dimensions o! all existing and • Indicate North <br /> proposed strucWres on'he lot i Show any proposed grading changes <br /> • Existing and proposed uti."�'c.^ • Show measurements � <br /> DO NOT WRITE BELOW THIS L!NE � <br /> PERMITCONC 1'IUNS <br /> 1.All calls'or inspection shall be mad?24 hrs.in advance- phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of[verelt Design ard Cons;ruction <br /> Star,dards and Specifications. � <br /> ,3.C���-oc��fOn,.�(�der$�qun�lF��rvi�e_4.8�f�fs���efgreyo�uid�g.�T�Q�L FRE E NUM gg R'(_$00-424•5555. � <br /> f - h l t- 1 T ..,f��. !-Y'I-'I�.'�JV6:1! <br /> Bl' TFiE F1'RLT.0 7(iF(I�;:; Ihl.`iF'ECTOR. � <br /> i �J91= f'll,t� tC DF`•:(1INl1GF: ;;YSTF_t1 AS i l"inUTI' :) �i]f� lili41N';r"'01_IT`-; , � <br /> %:" ANl L.[1T �-�RADE CH�INLC;i MUST HE fiFl-F"�[lVl:1? lt ' II;E <br /> FU�Li:�� �dOnK, INSF'ECTOfi. <br /> ', I L FF CT'I Y .'_:'fF�E_l 9 CL�AN Al' Fll.l_ 7 ThIE�;, � <br /> ,, ?NS7ALI_ SdAT�F F'�[)XE"S TO GR/lDC (-1T THE EIVii �L i;r_�I�t�, � I;t1r:? ZOhd <br /> 7. I I(lf'E �UfiF Df:lVEbJ(lY5 ARF COhiF'LGTEI_" �UfiEI� r � 1=DPE � <br /> ilR[V] WG Of•J lHF_I°I. � <br /> 1.C� , i�P.!5' DAI°i(1GE TO T1-IE CURF_: i .�!U ;IDFId(-1LK: WILL R�: Ft[ F'(�I1�ED <br /> 10 1"HE �iATISf=F1Cl I01�1 01 fHf- �'LIBL_IQ IJORI'..�5 DEF'T, � <br /> //. IrywYmBP C��`cifif,jww,� a.r''.t"az✓ S,ao� ��` K� �'¢7°St�Iuv�G,� Y6 0� <br /> Cm+�c7t' li/�t/� !o"PY.c 70 '�-f�c,:Z<-%��. ,Lroz,..� cYn�.�,., -Gn.2cr .c.v .Ltn.ar�_ <br /> /' �'�^J�'�� �i.,Oi,�.�I�'��.�X�/l.:l ��d.-.i e�Z��L :� LC.,-- -(l�U 7lvt�.L��/L�L . <br /> �f <br /> ACKN06VLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ac�rees to hold ano save h��nr <br /> less �he City ot Everett from any and all claims lor damages, costs. <br /> 7�7 „ ��� expenses, or causes of actia� ihat may anse because of installa�ion <br /> ������� 9 L� O� and maintenance ol lhe imprnvement or other righ!-o(-way use hereto <br /> � � applied lor and further ayrees to remove same uU��: ���tice irom Ihe <br /> Approved lo�Consiru:tion Date Cily and�o replace publir, property damaged thereby. <br /> FINAL INSPECTION Date yL=-�r�/-� <br /> Apprcved as Cons�rucled Si na W re of A f �� �_ � <br /> 9 pp :cact Dcdc <br /> cveretl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AiVD THEREAFTER IS TO <br /> EveretL WA9E201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERL'�IT MAY BE <br /> Fhone�. 259-8810 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK GN THIS <br /> PROJECT OVER 90 D�YS DURATION. <br /> � "4 <br />