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s <br /> I <br /> I <br /> I <br /> I <br /> � .S I <br /> Date_ct?�d��7 �,.����. ��,�,,.,�,�,m��p /�`�_ I_� � <br /> qpplicahon Fo� nin;i D.,i . O �� / __;/.I< <br /> � <br /> PUBLIC WOfiKS PERMIT r°^;�,:;���°° :_ ___ <br /> iasa�oni.F�«Ve�e S_�__ <br /> Bn�nnce�un S �� <br /> Print or Type Only <br /> /lsC, l dYlS7Yu c�,,, �CI. /� � S L-�S!P�� !� J/�d �� �(/(���� <br /> Owner Mailinp Addres- Cdy Zip T— Phone <br /> � — <br /> Applicant Mnding Addr+ss Clty Zip phone <br /> Dcscrlbe ProposeA Work _JJ�t'('l ���Ol � LQA f Cy� �QA / <br /> P�oirrl AdAress(��1 known 1��fp 7 thi�T.�L�_ � <br /> I —_- L��--�" � <br /> Atln�;h lou� (�f) copi�t ol plane Wr p�oposed work� Draw to scale and nole tha lollowing as apP��cable: � <br /> • Properly lines • Crnlerlioe of slrect ♦A <br /> • Outline nntl dimensions ol all e�isting and • Indicele North v� <br /> pwposnd strurWrr,s on the lot • Show eny proposed yradiny dm�iqes <br /> • Exislinp and C�oposcA utiidics • Show measuraments � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDIiIONS <br /> 1. A�I culls lor inspe�hon shall he made 24 h�s in advance � nhone 259•8815. � <br /> 2. All work 5hF111 be pCr�onnn�J m accordance with Ihis permi� and c urreM C'ty nl Evere�l Desiqn,na Constructim <br /> Stendertls end Speciticohons. '� <br /> 3. Call Location Untlerground Service 4B h�s.belore you dig. TOII FREE NUMBER 1-800•424•5555. � <br /> S. USE F'UBL.IC DFA2NA(�E ?V'': I'f-ri �'�!? F,':r�r� n� � -iir O <br /> b. ANY L.OT GRADf=_ L'HA�i� ' � <br /> FUBLIC WDRI:S IIVSFF /w <br /> va <br /> �:tfP f�l TY S i�;[ETS O <br /> I <br /> � ��;TALI. I�lF)�F�Ft Fl� aS � _ . . �. ,. . , � I <br /> � . ��,,F , � i � . , . i � , . � . . <br /> ACKNOWLEDG[M[YT OF CONDI�IONS <br /> The und,rsiyned owneUapplicant hereby eyrees lo huld and snve harm- i <br /> � less Ihe City ol Everetl hom nny and all claims Ie r Aamages, cosls, � <br /> / /� ezpr,nses, or causes ol aclion ihat mny erise 6ecauso cl installation <br />' 2 � _/����y .� �F� `;�,g and mpintenance ol �he improvr.ment or other righPobway use hereto <br /> ��� a applietl �oi end lurthar ngrees lo remove aeme upon nofice Irom the <br /> Approved lor Cons�ruction �e CitJ'�nJ'�d t¢replace publir, prnperly dameged Ihere6y. <br /> �° i- � � / ('``— K-E� U'X�E�p/GZL 1�-[CKt. Ctj <br /> FINAL 1 CT � Dale (���.I4.:��'� 7.�z��0—_ _. <br /> ApprovedesConsuuclad tig aWre I�pp6canl Dato <br /> �•�F����� PUfiLiC WORKS UEPART�dENT WORK AUTHORIZFD BY THIS PERMIT MUST �E STAFTED WlTlnl� <br /> � 3200GeJarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED A�.'D THEREqFTEP I; ��� <br /> Cvere�l WA QU1 BE DILIGENTLV PURSUED TO COMPLFTI-�N. llllF, PERMIT M�'.' t�f. <br /> Phone' 259�oJ15 CANCELLED BY THE CIiY UPON ANV STOPPAGE pF WORH ON Tl1�ti <br /> �ROJE�i OVER 90 DAVS DURATION. <br /> I <br />