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HnH <br /> � � � <br /> � � y <br /> qa H <br /> t' yy <br /> Y � <br /> K y �, ��u � � , . ,. . 9�� �e`f i <br /> �,:, <br /> Date ', ,' y� <br /> �LI H '�-7 tnne ow� .____�_�i.�r"�(�.7"' <br /> � , , ly�nlic�,�ion For <br /> 4 �o � PU �L.IC VI�RKS PERMIT r��°°°W°,�s'�� ���� _ <br /> inmiFce S- <br /> y Y,7 o i�.;sanui Fe ;.�.� 5 <br /> O <br /> OH o <br /> H � g �. .� �. � TO P��TING__. �- �� 3 �:,�:,���o,:,, s�_���_ <br /> Print or Type Only r .. r: v� o <br /> H y � ,.�.,i �h [� �.-7i ' _� � <br /> `� H � o� o � t� I.��. ..__ .!-. <br /> � y z r%� w .-i �o m . <br /> H y � -? . �.�, �- �� ,��-�^�'� ��tl�� ,il�N—�1��` t -� � ' t_ 'I I�' < 1���'�: � _ <br /> �.r C/J Ov:ne� P` �c11��,yip ,�y,,s5 dG y J�� Phone <br /> M CJ Ny'UY� <br /> nd[n N OI— � �"� W <br /> �� � � �� /'r Y, ' -_' J �IS��Pt �_ ���f� �_ /C. '-__- -____ <br /> ----�=�----- <br /> z N f/� Aophcant Mailing Address City Z,n Phonu <br /> Hd [n I <br /> Describe Proposed Work ���y �I l�, I �`� <br /> — � <br /> Prolecl Atldresslif knownl � /Q� — �Z �=�'==1�y � <br /> Attach�e:u(4) copies of plans tor proposed work- D�av: lo sr,ale antl note ihe tollowing as a�plicahle�. �� <br /> A Property Liu�s • Centerline nf street /A <br /> • Ou!I,ne and dim�nsions of all ex�sling and • Indicatc Nor�h V� <br /> proposetl struc�ures on O�e lot • Show any proposed yruamy i.hanyes <br /> • ExiSUng antl proposed Wihties • Show measmements �p/t <br /> ��+w d�L <br /> DO NOT WRITE BELOW Tt11S LINE <br /> i ' PER�dITCONJITIONS � <br /> ' 1.All calls for inspeclion shall be matle 24 hrs.in advance-phone 259•8810. � <br /> s 2.All work snall be pedormed in accordance with Ihis permit and current City of Everet�Desiqn and Construdion <br /> f�t Standards and Speciticalions. <br /> 3.Call Location Gndeiground Servir,e 48 hrs.before you dig TOLL FREE NUMBER 1•500-4?_4•5555. � <br /> Y'�' ',{' (�_ `{.����cn,.¢4- /�7 dd'9`.s GYlf/Y'd.� �' �9' `/� � <br /> �r� T / / <br /> 0_� � <br /> —� � <br /> 1 �— <br /> i�i � <br /> _� <br /> 4CIVJ0'�^JL!'DGEMENT OF CONDITIONS <br /> 's' <br /> The undersigned owneUapphcani hereUy agrees to hold and save harm� <br /> 'r' -- less ihe City of Everett Irom any and all claims for dama9es, costs. <br /> J Cxpenses, or causes cf ar.lion ihat may anse hccause of inslall�tion <br /> // � � �-.� and miinte�2iice M the improvernent or other righbol�way u�c herelo <br /> __F�/���-. ' aPP:�eJ for and lurther agrees to remove same uPon ncuce Iwm .. <br /> Ap !c d for Co iruc'� ^ /�ate Ciry�nd to rePlace Publi.:OroPertY dama�ed thereby. <br /> I <br /> ____�"'���.��� /� %>' � � ��_ � ,�, <br /> �.-�---����--�- , � -,Y�,� iJ / �ti�., .�/� � <br /> FINAL INSPECT�ON � Oate <br /> Approved as Censtruc�ed Signature ot A phcaq� ���Q <br /> WOHK AUTHORIZFD BY THIS FERMIT MUST BE STARTED WITHIN <br /> everc�tt PUBLICVJORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSiree� BF DILIGENTLY PUFSUE� TO COMPLETION. THIS PE7A11T MAV BE <br /> Everelt lM1'A 9R201 CANCELLED B'i THE CITY UPON ANV STOPPAGE OP VJORK ON i HIS <br /> Phone:259-0810 PROJECT O:[R 90 DAYS DURATION. <br />