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C t^ ~ �^ � /�_ <br /> M � y 7'��/�� r��nroc wods amma Y2 7.-f�/ <br /> Date_—.- <br /> AppliCalion For ������ �co�.• � ��- <br /> � � = PUBLIC WORKS PERMIT <br /> � � Publ¢WO�NSFax � � <br /> Tpiql FCB <br /> K yyyW p ���ssa�oi iceaa�a 5 <br /> � y H Baiancc0ue S `�U��� <br /> y Print or Type Only <br /> � � � � J <br /> � � � �lA.�/��i ,�m�� 7�ll�3-G��J'S� ��r�rc'�f ��11'l ?�h-179�/ <br /> N � Owner Mailing Adtlress City ::ip Phone <br /> 2 y � <br /> z 7:J /-�.3/� <br /> HH C� � ' � � � _ � �- � <br /> � d❑ y Applicant Idailiny Address City Zip Pho:�e <br /> t9 ro trE /' / '/ ''' """���((( <br /> y p y Describe Proposea Work ���{� (��7�� /��/ll(�n�� � <br /> ✓ ' <br /> _— � <br /> Frolect Address lif known; <br /> 2�l��Oyn ` �' <br /> Attach(our(�1)copies oi plans for propo�ed work- Draw to scale antl note the following as apU6cable: � <br /> • Pwperty Lines • Centcrline o�street ♦^ <br /> • Ou�line and dimensions ol all existing and • Indica�e Norih V� <br /> proposed strucWres on the lot • Show any proposed 9rading changes <br /> • Eaisting anC proposed Wili�ie5 • Show measuremenis Y <br /> W <br /> -.. DO NOT WRITE BELOW THIS LINE � O <br /> i � <br /> I �_' PERMII"CONDITIONS <br /> � i.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> � 2.All work shall be pertormed in accordance with this permit and curmnt Cily of Everett Design and Constructlon � <br /> 1 Standards and Specifications. <br /> , '�� 3.Call Location Undergrou�id S^rvice 48 hrs.belore you dig.TOLL FREE NUMBER 1•8C10•424•5555. � <br /> ��� , ,, <br /> . � ���.L� ��,c �l•�tc�t�zq L�c-ZS—'J/ �.�v �7tcGEcc_ Cc�nzl:�.y C�z„�Jc�.�p-y � <br /> � ll2c� /co ll?�Co"^"�,.,y LUo+�� p��.. C�/.?cc�,:'c.ia.c� . <br /> / �� � q <br /> 1. �� .J�. -��� .G� ,�c 11P, cG�u�yr�[' � � <br /> ��� ,ercvz'��. d��ti«.y v�„ G� sr. , <br /> ,t��J C�c.tfi. •/Za..-y/J,J� -�� S_ lt�LlG[CIR�/'✓ ��ZCC.1.7 G�: /Li�l�trT�.:.�i ♦^ I <br /> ����� �i,p�� �G�214C'i!l �GK�W .�LCiI� -l2i'C��� �LCI�:�. � . <br /> � �__ <br /> a <br /> __� <br /> � � ACKN06YLEDG[MENT OF CONDI7IpN6 <br /> �� __ ihe undcrsipned owner/applicant here6y a�rees to hold and save harm- <br /> �_', - le,s the Ciry ol [vereU Irom any and all claims lor damages, costs, <br /> n Cxpenses, or causes ol aclion Iha� may arise because of ins�allation <br /> ���� ,E� /�v ��//�2 and mainlenance ol the ImU�ovement or other right-ol-way use heretu <br /> �y����''�� ann���� �o� and WrOier agrees lo remove same upon notice irom Ihe <br /> ApProvcd for CansUuc ion Da�e �{�y;�i�����replace puhlic properiy dama9etl ihereby. <br /> � ��_ ' <br /> �� c.��-fi . , > .y'L. I ' C �� <br /> FINALINSPECTION Date -��� ` • I� �C� � <br /> Fpproved as Con;�ruc�ed Si na ure oi Appficant Uate <br /> �� PUBUC WORKS DEPARTMENT WORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreel �E30 DnYS OF DATE PERMIT IS ISSUED AND THEREAPTER IS TO <br /> Everett,JJA98201 BE DILIGENTLY PUHSUED TO COMPLETION.THIS PERMIT MAY BF <br /> � Phone:259�8810 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br /> PROJ[CT GVER 9a DAYS DUFiATION. <br />