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i <br /> I <br /> �8�@__��� rum�cWnr�nrr.rm�i(.� cJ �l — ..�.�V� � <br /> III�O 0-YI I —Q–{O�I_V-i'l-�/ <br /> Apphcahon For – <br /> PUBLIC WORKS PERMIT °°°��°W°,�,F°° : - <br /> r�,r��.� <br /> Mu�no� Po�Va�n S, — <br /> PxieicnDue S ���� _ <br /> Print or Type Only <br /> I <br /> .z��-,�k„, ��s �� tG,P. ��z �36��,o� .s.� ���.�,� y�3� ��s y�y � <br /> _ 1 <br /> Owner Mailing Adtlress Clly ' 2ip Phone � <br /> s� 9f A.d�v�_ _._ <br /> Applieant Mailing Address City Zip Phone . <br /> Drscrib�• P�oPotied Work J.��''� �� ��y�� �S �� � "" �6�e✓. _. _ .._ . <br /> L�/ 1y /.IJPI�'[/ P0� ����J�__._._-- .-- '_. ___ � <br /> --- ---- -- W � <br /> �a2B - :�09��sT• s�; � <br /> Project Address(il knownl _ �---_ – <br /> Atlach lour 14) copies ol pinns lor proposed work� Draw to sr,ale ard note Ihe lollowin{�ns applicable. �t I <br /> • Property Lines • Cenlerlme ol slreel /^ <br /> • Outhne end dime.nsions o�ell ex�sling enA • InAicate Nur�h V� <br /> proposed strudures on �he lot • snow a�y ��onosed��an���� ��n,�,<i�,s <br /> • EMisting and proposed ul�'ities • Show measurements � <br /> �O NOT WRITE BELOW TMIS LINE � <br /> PERMIT CGNDITIONS <br /> 1. All r,alls�or inspec�ion shall be maAe 2d hrs in adva���e� phone 259•8815. � <br /> 2. All vrork sLell he per�ormed m nccorAance wdh thic pe�mit and cun ant Cily ol Ever��� Desiyn and Conslrur,lion <br /> Slantlards and Specilicetions <br /> 3. Call Location Underc�round Service 48 hrs before you dig. TOLL FREE NUMBER 1•800•424•5555. � <br /> � r.N/� s�.'�E:.✓FG<� �U���'�'' � �n41/tr�.,' �/''L'GC�:.�✓ D://:i'v:– >i .. O <br /> C�Or✓ST.iacr.cnl /�Je.sr .R_F if'E.'L/.'CF�' <br /> .S, �pNn�FlT ,vG�UI�$/�drlTJ jt� IJ.PAi.t/Qli£ Sj/S7ci» � <br /> �. �.CADF LnT SO F!f a/Jl' -� 7.ni'f+�7 �,✓c ScGcr<< .c.�,ti�:� � <br /> LoTs� O <br /> � /�) �T l�t.�5'�/ OA'GAn/iC �rlAiEtiqC O�/To .�i.2j�°c'%v ' _. ,'.t � <br /> �� l-- D�.cJ CHf�n/Ce'S n�E n:_<C£_C.i/'�'� .I�F�)i�l":�1�_ �Jh4') <br /> j1i.SPF TivA/ 9�PE` it�-�;��;,.�n <br /> ACKPIOW;EDGEMENT OF CONUITiONS <br /> The imdersigneA ewneriapplicem hereUy agrees lo hold and save liarm� <br /> --- – less ihe City ol Everetl Uom any enA nll clpims for A�unayes, i.osls. <br /> expenses, or causes ol achnn th�l may a�ise b�cnuse ol mstalial�on <br /> .. � "` � h7 � .9", and maintenanr.e ol Ihe improvr.menl or olher righl�ol�way use h�����to <br /> applied lor nnA lurfher ac�rees to remove seme upon nolir,e trom Ihr <br /> qpprnved jor Constrwilyrin ' � �e�e Ctly and to replace public p•op/er'lY demnged the�eby. <br /> ���;r� (, �– / /� � _ -z�Y'.f�}�.. �1 1 �(i. i `� �r=� / <br /> i `y <br /> FINAL I SPECTION �-' Date �'�a.._..--���— �j��L' <br /> Approvetl as Construc�ed Signatu e ol APPlicanl Dnle <br /> �.����p ?UBLIC WORKS DEPA9TMENT WORK AUTHORIZED BV THIS PEFMIT MUST BE STARTED WITHIN <br /> 1A0 DAVS OF DATE PERMIT IS ISSUED AND THFR[AFTER IS Trl <br /> �t•� J2U0 Ceder Slreel BE DIIIGENTLY f URSUED TG COh1PLf 110N THIti 1'! f��MIT tdAV Rf <br /> � fvcrelt,WA 98201 GANCELLED BV THE CITv UPON ANv`�fOPPAGI �`I Wi�Rrc tiN l i�lti <br /> Phnnn. 259-Bf315 PRO.IfC1 OVER 90 DAVS DURATION <br />