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i <br /> � <br /> � <br /> Date Z —��—�� �'nni c Ymne Pnrm�t• �� 'K' <br /> AppGcalion for iann o.m . .—�� _���Ci�'__. <br /> PUBLIC WC►RKS PERMIT �"°°, w°,",°P <br /> ,����«� s _ <br /> � .,<.�,�� �.�„a,�, s <br /> Print or Type Only <br /> �,.,�.,�,��,�. s� <br /> �7/- qi�� <br /> �1��vcl �O�.S�rvr/, oh C�o , 1� c. ao/s'a �'�5�: /3e/��yl�o� y� �s ' ' <br /> Owner MaihngAAtlress Cny iil� Phcne II <br /> SQ/�2.P —_ I <br /> Applitanl Ma1Ln9 AdAiess GtY Zip Phonw <br /> Describe Proposed Work __ SIH G N?�� ��/ �PL! �� ._ ___ <br /> L.p �` a S' �.ars eh {�a V�z - - --- — --- <br /> Pwjecl Address lil known) �d�B ` �a9 �n–s� «- __ ___ � <br /> � <br /> ldtech lom 14)ropies o� plans br proposed work� Draw lo sr.ale anA nnle Ihe lolluwing ns apPhcabie � <br /> • Property Lines • Centerline ol sPe�el ♦A <br /> • Oi�tline and dimensiocs ol all eKislir.4 nntl • Indir.ate Nor�h V� <br /> proposeo structures on the lot • Show an� aroposed gr�tlinq chanqes <br /> • E.isting and proposeA ulilities • Shcv. mrsasurrmenls � <br /> DO iVOT WFiIE �ELOW THIS �_IN[ O <br /> PEFMI�CONDITIONS <br /> 1 All culis for inspacllon shall be made 24 hrs.In advance�phone Zb9-88�0. � <br /> 7.A'�worl:shell be performed in accordence wi�h this permlt nnd current Gity ol Everett Design end Consiruclion <br /> Stantlards and Specificetions. <br /> 3 Cell Location Underground Service 48 hrs.before you di�.TOLL FNEE NUMBER 1•80C•424•5555. � <br /> ; i, � : , , . . .� . . . . � i , . <br /> , , ��, :i i � .� . :,� , i � , � <br /> $E f UGI.IC DFAINA(iE 3�/SlI'IH AS F'FO'JIDED F�' O <br /> idV 1_i7 f GkAP! GNAIJGFS Ih J5T BE G1F'P F" � <br /> "'IB�.rr. W�IRY.G TIdGF�rTOF. I_ <br /> V� � <br /> GF_P CIT'Y STREEI"S CLF..(1N AT F1Ll. TI ! O � <br /> �;ISTALL WATEF BDXE5 TO GR�DE ,-OT �I-�1 !_! i li� <br /> . .� � . , � � . � ,i . � , . , � . ,, . . ���.,�i` f�•FI �. <br /> ACKNOWLEC.,[M[NT O�CONGIiIONS <br /> 7 r���undersigned ownevnpphcant herchy ayrees�o holA and save harm� <br /> ------ � -�--- � - - � i�^,s the City ul Fverett hom any and ali clalms for Aamnges cosls <br /> � , repensr,s. or ceuses o� achon Ihat may anse bec2use ol rs' ,Il��ion <br /> r�� /��� anA maintenancr, ol Ihe improvement or other �ighl�obwny •.�sr here�o <br /> ' �nni�e�t io� antl lurlher ayrees lo remove same upo•i noticc hom ihe <br /> Apprcv�lor Con rur.tion D�tv �ily,nd lo�eplac��pubh property damaged thereby <br /> l �/ / <br /> / r i {//� �i <br /> fINA - SPECTION � �/���dE• --y// - � — --"�— � _ /�'�.-- <br /> Aoproved as Conslrucled S�m��l��re ���Ann�r,�nl Dale <br /> WORH AUTHORI:CD BY THIS PERMIT MUST BE STARTED WITHIN <br /> �rr��t1 PUBLICWORKSDFPARTMENT 1B0 DAVS OF DATF P[NMI7 IS ISSUED AND THEfiEAPTER IS TO <br /> � 3200CederSireal BE DILIGCNTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt.WA 98207 CANCELLED BV THE CIiY UPON ANV STOPPAGE OF WORY.ON THIS <br /> Phone.:59�9810 PRQIFCT f�VFR 40 GAVS DUR�TION <br />