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_ _ .�.-E <br /> i .�, <br /> � <br /> r <br /> i <br /> ��� <br /> � H Datf- -�:,��;Y� . . .., - n,en�:wo,wscP�me• --=��iJ.LU. <br /> A� ..�� emo oeo�.• _—_'— ! <br /> Q►►►]]]� APPIica�iqBFor .--__—__—_ <br /> ��� l F�,ee,wor�s Fna �� <br /> PUBLIC WOR�CS PET�I�I��N � Z" ro:T1Fe s ''.,�= <br /> n � iessnno� Fcrn��a �� 7 / p— <br /> �3�� �:; ---� <br /> ! �.� C� O b:� <br /> o�in�cc ouo ::l--f2-- I <br /> Print o� Type Or:y * °� �; ? :' I <br /> o a m �/ /� <br /> � ��' �JP n :-i � ��"l` '(o..�.J�: <br /> / /t" ' ui .n e� /�� <br /> �� S��'{�Y �/?_� /. (�rJ,«��`1'_0�/�!� �.�-//�f-' /�I/G�//��� % )z�(J <br /> ��l7 Owner Mail�nl,�`AAdr�5�5� N �j � __ C�IY Zi Phone <br /> � ��.i �i'-�' o .� o �- �- w <br /> p• Ogg � _r. oaoi� r �' , <br /> '~Y.N� � rJ� � o: _, au. s. rSricS _ . � <br /> �y —�qpplicant Maihng AAdress Ciry Zip Phone , i <br /> F�F // <br /> u //'f/� � �I <br /> � '�'� Describe Proposed Work __(,._,L��-(� 3 - <br /> � _ �o�� ! <br /> �� — W <br /> .. �-� '~ Prolecl Adtlress(it knownl ���(l �� �"p /'/ lL�------ � �I i <br /> � <br /> Attach four IA)coPies of plans�or proposec wo�k� Draw to scale and note ihe tollowing a;::ppilr,ab�e: �� j � <br /> � • ProPerlY Lines • Cen!urline ot slrr.et ♦A � <br /> �� • Outline and dimensions of all existing and • Indicate North V� . , <br /> � � proposetl siractures on the lot • Show any pro��,use'��a7�ng chanyes <br /> • Existing an0 proposed utilities • Show measuremen!s /1A <br /> W <br /> ,�-' ��; DO NOT WRITE BELOW THIS LWE � <br /> � C�' PERMITCONDITIONS <br /> � 1.All calls br inspeclion shall be matle 24 hrs.in adva�ce-phone 259-8s10. q <br /> 1 � 2 All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction ♦ <br /> Standarcb and Specifications. <br /> i ,_�'� 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE kUMBER'I-S00•424•5555. � <br /> ��� / <br /> � '� �'.�- a-���r�.-oc��ol�'�� c��r.� �- z� � � � � <br /> I �" � <br /> . � <br /> , "'�— � <br /> � `�-� <br /> a <br /> ACKNON'LEOGEMENT OF CONDITIONS �I <br /> '�'_� The undersigned ownedapplicant hereby agrees to hold and save harm� <br /> I less Ihe City ol Evereft Irom any and all claims lor damapes. cosls. <br /> � � � ezpenses. or causes ol aclion that may anse because ol installation <br /> �� � , �� ., c- and mamte0arfcE of the improvemenl or other ric�h4obway use hereto <br /> �� � applied J�anF��` r her a9rees �o remove Same upon nolice Irom ihe <br /> Appro e 6- .o n ruc 9/� � y / � Date City an(1 to re(� pu hc nroperry damageA thereby. <br /> % � � � <br /> / /� i/ i�� � �j7 �_ � <br /> Q��� `� % / y� � " � . . , � � � I : <br /> F: AL INSP-CTIO � � � � Date ' ' � <br /> ApP�oved as Gonstructed Si natGi of Appl ant Date <br /> WOR� AUTHORIZED BY THIS PERMIT MUST BE TARTE WITHIN <br /> everetl PUBLICWORKSDEPARTMENT 18U/DAVS OF OATE PERMIT IS ISSUED AMD THEREAFTER IS TO <br /> � 3200CetlarStreet BE DiLIGENTLY PURSUED TO COMPLETION. THIS PEFlbiiT MAY 8E <br /> Everett.WA 98201 C4NCELLED BY THE CITY UPON ANY STOPPAGE OF WUPK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAVS DURATION. <br /> I <br /> "_—__ i <br />