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i <br /> I <br /> i <br /> I <br /> � p p <br /> Date 1V�a � r�o��we,..r�,mn.p �Q( . <br /> APPli�ation Fm Flwa Deri . ___f]�L(J(�7� _ <br /> / <br /> PUBLIC WORKS PERMIT ���°°°w°��^��° ------ - -- <br /> .��.��.. s— --- — <br /> ��,,.��� �„�Pa� s <br /> FL,i,��n m,,. S ZQ�---- <br /> Print or Type Only — -- <br /> ,��,I„M �J'n�,,�G�-. �.x��T a �u.�p ��P�n.,S 9��Zti�,Q �s 3�Q�_- <br /> wner Malling Address Ctly Zlp Phone <br /> )(� — _ __ <br /> -��jp i a Maihng AdAress Cdy Zip Phone <br /> Descri6e Proposed Work �IQJ_�1nyt�i.qLp4,���LL Lq�rcH,�QC� - <br /> �% � . <br /> Pro�ect Address(il known) � � — ��D ry _ � <br /> � <br /> Attach low 14)copies ol plans 1�r proposed work� Draw lo sr.aie and note Ihe lollowmy as applir.ablp � I <br /> A Property Lines • Centerhne ol street ,A <br /> • Outhne and dimensions ol all e.ishng and • Indicnle North V� <br /> piaposed siructures on the lot • Show any pioposeA 9radmg chan4ns <br /> • Eristing and proposed ulildies • Show measwements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All cells lor inspec�ion shell be mede 24 hrs.in pdvance�phone 259•88�0. � <br /> 2.All work shall be perfnrmed in eccordance with this permit and current City ol Everett Des�gn and Consuuction , <br /> Slenderds and SNec�'i..*�tions. <br /> 3 Call Localion Unde�graw�d Service 4B hrs.be�ore you dip.TOLL FREE NUMBER 1-800•424•55.ri5. � <br /> ' � . .� . .. '� . i... . I ... . I.'i �. � �.' I i <br /> ' 1 ' ''�L { ilt'.I_: � i ,�; �; ll:d Li iilf� . � I <br /> 5 UGE F'UE�LIC DI�i II,IAI:IC ii :.�TEM fi5 `-���0'✓Iiil.'� . � � <br /> („APJY LO i f;RADF CHA!JGES MU6T E�E AFPFO'.'� � <br /> PU[�LIL: WOftl':� INS�'�CTOF. <br /> 7,I�C:EF CITV STi f � T'; CI.EAN �aT Ai I TI�!E"�� � <br /> L3. I NSTALL W/l'f f ' <br /> , .. . .. �..i , ..,�. ... i,. . . ,. .�. , <br /> +,��}'f" ';III' I� f.� . . . ' . , . �� d '. � � - ' �' � <br /> � , � O <br /> a <br /> ACk.Ntlbl'I ( Ul,l 1.11 Nf lll CONDIII(1N i � <br /> I <br /> Tlu�imd��ivqiled uwni•�.�PPLcunl h�•ri•1��'��g�t�as to huld and Sav��nnn � <br /> ----------��—-�"-� � -------- � - � � Ir�;s Ihe Cdy ol Eve�etl Irom any and all Uaims lur dama9es. cusls. <br /> / r.pen5es, oi ceuses ^� xction Ihat may erise because ol in5tnllnlio�� <br /> ��( '� L'� /u �- v `5'Si and ma�nlenqncr, ol �he improvemenl or olher ri9ht�e6weY use hi>reto I, <br /> 1�L �'� f�" Appl,ed lor and lu�lher a9rees to �emove same upon noGce Irom Ihe <br /> Apnroved hr onstructio ���e Cdy and to repl;�ce puL6r, properry damnged Iherehy <br /> 9NAL I SP ION /� Dete �Isa ��'�—���'�-/�-- <br /> pnrovcd as Cunstrucled S�ynnlure ol Apphr,anl Date <br /> WORK AUTHORIZED 31' THIS PERMIT MUST BE STARTED WITHIPI <br /> i�v��rrt1 PUBLICWORKSDEPARTMENT 180 DAVS OF� DATF PERMIT IS ISSUED AND TH[REAFTFR IS TC <br /> � 3200CederStreel BE DIUG[MTLY PURSUED TO COMPLETION THIS PERMIT MAV �C <br /> [vArett,WA 98201 CANCELLED BY THE CIiV UFON ANV STOPPAGE OF WONk ON THIS <br /> Phone.259�8810 PROJ[CT OVER 90 UAYS DUFATION <br />