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i <br /> i <br /> Date��'_��� �>„�,��•,o,�.r��m�. —_f��-�tJ��_ <br /> Apnhc�;ion Fcr mm� o�ni •�-B�–J-��+�-/ <br /> PUBLIG WURKS PERMIT �°^;�„��e`°° : __ <br /> i.�.s apw F.•e re�a S�_ <br /> Printor ";peOnly "'" rDOe S—� — <br /> �? .C. [.r,�s�,,i, �.�,� �r.. _1u_JC..F_v�vn7/ /1�oll /a��� l��U� � S �— �' >�� <br /> Owner Ma�liny Aadrr.ss City Zip Phone <br /> �fa.l1S� _— __ _ <br /> Applic�nt Mniling Address City Zip phone <br /> Descri6ePwposedWork ���!(�� ._r�_(�d�' 07� �JJAffrLt /'"n��(� <br /> W <br /> Prolect Address�if knownl _ ��%j - �u9 r'� Sr .S<== � <br /> Altnch fovi(4)copies ol plans for proposed work� Draw to scaln and nole Ihe lollnwmg as appGcaulP. � <br /> � Properry Lines • Centr.rline ol sheet � <br /> • Outline end dimeneions ol all ueisling and • Indicate No�th <br /> proposetl strudures on thr lot • Shuw any proposed<yaAing ch�n9es <br /> • Existing and proposed utihlies • Shnw measuremnnls � <br /> DO NOT WRITE BELOW THIS LWE Q <br /> PEfiMIT CONDITIONS <br /> 1. All calls for inspection shall be m��de 24 hrs In aAvance- phone 259•8815. ^ <br /> 2. All work shall be porformeJ m accordance wilh Ihis permit and r.wrent City ol [verett Design and Gonslrucl�on � <br /> Slnndards and Specilicalions, <br /> 3. f.nll Location Underg�ound Service 4C hrs,belorn you dip. TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> r„ ��i'f L.I?T CikALE C'1-INNL. ' � <br /> F'UE+!.fC 610RKS TN5"F� , <br /> ! �' CITV S'IFLF'. ; Ci � <br /> IALI. I�:A'fEF' EOXFS : ., i,iui'it n � O <br /> a <br /> ni.KNOWLEDC.E�NENT UF CUNDITIGNS <br /> Theundrrs�ynedowner/epU���BniherebyagroeS�ohDldenA9oveherm� � <br /> less ihe Cdy o� Everett Irom eny and ell claims lor damages, costs, I <br /> � � expenses, or causes ol ec�ion Ihat mxy erise becnuse of InStellAlion <br /> � -� j /�����/ � end maiMenance ol Ih� imp�ovement nr other riyht�of�wey use herelo I <br /> '� ` npplied lor and �urlher agrees lo removo seme upon noti��e Irom ihr I <br /> ApproveAJo� Co��:'rw l�a ete �i�y and to replace public property damaged Ihereby. I <br /> � <br /> ' � ��1=� �,� /,� I�C G�z,; (� �LCL1'�en�c Ct7ec�r,Z>Cc� <br /> / r, ( <br /> FI AL INSPECTION '" ���_1 02tr ' '�'� C �u�yl k�' ���L�.l--_. <br /> Approved as Constructed Sign lure o�Appli nt Dnte <br /> rvrmtl PUP� IC WORKS DEPARTMENT WORK AUTHGRIZED BY THIS PERMIT MUST BF STARTED WITHIN � <br /> � 3200 Cedar Sireet 100 DAVS OF DATE PERMIi IS IRSVED AND THEREAFTEP IS TO , <br /> Everell, WA 9B,^.01 O[ DILIGENTLY PURSUED TO COMPLETION. TIiIS PEFM'T MAY EE. I <br /> �� "q ����_ (;�NCCLLED RV TH[ CITY U?ON ANY STOPPAGE OF WORK ON THIS <br /> I'ROJI C1 (1Vf H �u� [7qVti pUH1TION � <br />