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�, i �;_ �� , <br /> Date 5��i-�`� a� PubLt Wo hs Permil s �'fJ'— Z/O <br /> ��ppliCa�ion Fur 110 <br /> � om�.oe�•.x__.g��[�7__ <br /> R�,,/ ql ////��� �W�) ^�.[ l <br /> \ � i�'L�I`!r •f `��/1, .�tvl � � �i Ni t � �G Public Warks ice <br /> TolalPoe S <br /> �� Le55ApC�� FeePaN �u <br /> Print or Type Only � � � e'�'°°Qo°� 5—�'�Ob� — <br /> �v <br /> /'� � ` -� C I^ / �/ <br /> rnG,,,l� 1 pv1��_F�_ �� jF�--��y, J-f-- �//LIG`�rbyl /!T ��� ��s CD 71—�/Y�• <br /> Owner Mailing Address City Zip Phone <br /> ���2�.Q. - _ <br /> AppLr,ant Mailiny Address City Zip Phone <br /> A C � <br /> Descri6e Proposed Work _ i�nN� \I II R�N�1�� �IdYl10 ��iv7�' --�_./'S/1`C,1 /�('{� _ <br /> " J <br /> Praject Ai'dress(if k.nown) /t��2� — ��� .O.f� .$�C �P1 � <br /> Attach four(4) copies of plans for prcposed work- Draw to scale and note the followin�as applicable: O <br /> r Property Lines • Centerline of slreel � <br /> • Outline and dimensions ol ali eristing and ! Indicate Nc rih <br /> proposed structures on ihe lot • Show any proposed grading chan9es <br /> • Existing anrl pr;posed utiti�ies O Show measurements � <br /> �n•�• ��� <br /> DO NOT WRITE BELOW TH!S LINE <br /> PERMIT CONDITIONS o <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•$810. � <br /> 2.All wr�'��shall be performed in accordance with ihis permit and cunant City uf Everett Design and Construction <br /> Standards and Specifications. <br /> ation Under round Service� y g R 1•800•424-5555. � <br /> 3 all Loc g 8 hrs.before ou di .TOLL FREE NUMBE <br /> .. .� _. .. � _ ,.� , ..., i,� !I; . � . . . .. <br /> .. 4 i _ _.. � � � <br /> . . �'J � _��L �i �i � � [- i �L I`i !i �_:i`(-�, i.,i . �. , _ <br /> iqY' LC'iT LRF;D� Cili^-vidGES i'll1�T if fi� ^ ,. . <br /> ��i� jl. ���`1f.J T��. r��ror. � �.,, <br /> Er� cr.r� ��rs;[ c, , r�_�r-;�� r�r ^�_�_ rr� � <br /> � i.;ra� i ��� rer ,. ,_ ,,., ..7 . ,;.. ,,,, , - .- ,,: ♦� <br /> � i�/� <br /> '' �11 r t;� �i C r, ..; .., . .,.. . . i .. ,. .._, . <br /> _�. . . . . .. .. <br /> . . . _'�. .__ _.� . ._. � <br /> 1� ���.�fl f �� ". � . <br /> 1L'. Q.r��y�Q�p .� .�/W ''L'GULN' �Z .��fUf�LULe(i �GC2 /GE�4'!iL[s[/ � � <br /> �L-t, �Ci�� .�'J�. � fI �J� A � � Q �C <br /> < 1 �.2�I.:._� !Y Jf"/LG-� /l7GtL.�%.E/ �C/L�Lf�'�(- �.Pf�f• <br /> . i: � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _, Th�undersigned ownedapplicant hereby a�rees to hold and save harm- <br /> -�-- I��ss the Cdy ol Everett from any and all claims (or damagns, costs. <br /> / � expenses, or causes of action ihat may arise because of installation <br /> �j��� .jy ���`y� �� and maintenance ol the improvement or other right-obway ��;e heretn <br /> Approved lor Con�uction ---1L— apphed for and lurther agrees to remove same upon notice Irom the <br /> Date City and to replace puhlic property dam2ged thereby. <br /> FINAL INSPFCTION Date <br /> Approved as Consiructed Signa�ure ot Applic�nt Date <br /> everett PUBLICWORKSDEPARTMENT WORK: AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 D�YS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA )8201 BE DILIGE-NTLY PURSUED TO COMPLETION. THIS PE�MIT MAY �E <br /> ohone:259��810 CANCELLED BY THE CITY UPON ANY STOPPAGG OF VJ�Rh ON THIS <br /> PROJECT OVER 90 DAYS DUR�TIOPJ. <br /> � <br />