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Date�E o�e„�Wo,�.Pa,m�. 8w - 2 3.3 <br /> Apphcation For eiao Deo� � <br /> PUBLIC WORKS PERIIAIT °°°;�„e;`°° s <br /> leas Appl.Poe Pe�E s <br /> Balence0ve 5 �9� • <br /> Print or Type Only <br /> �eEc, 790�9 <br /> ��'1�C U R-o,�l (.(_� I� �Ci i��x >-2 7 SF,�{�t Zv Ja `�� �� � � j s �'a �c; <br /> Ow q� Mailing Address City Lp Phone ' <br /> �f �'+i- � /�Es�iniT //F.C� / _ <br /> ��t � (o�'fia¢n�io�� Z'�v L "a^ ST TiH�o�,,-l�v� �l v 5�v 2 �> ��2 9`( /7� � <br /> Applicant Mailing Address CRy Zip Phone n <br /> m <br /> DescribePr�PosedWo�k �f/�lAcs �.g2-f,y„� y�02�'1-�.,e,�5 H-1- 5'iiYz �'l� '��S � �P�U£C -� I <br /> =a �v <br /> �. � <br /> N = I <br /> v <br /> m <br /> W c � � <br /> m� <br /> Projecl Address(if knownl '� '� C ��?n a �u��—�tJ S � � m ' <br /> s —=i <br /> Atlach feur(4)copies ot plans for proposed work� Draw to ecale and note Ihe lollowing as appiicable � m . <br /> • Property Lines • Centerline ol street � �o z � <br /> • Outline and dimensions ot all eaistin4i antl • Indicate Norih q � ! <br /> proposed structures on the lot • Show any proposetl grad�ng changes � � <br /> • [xisting and p�oposed utilities • Show measurements � � in <br /> � <br /> DO NOT WRITE BELOW THIS LINE O O y <br /> PERMIT CONDIT!ONS = m <br /> 7. All calls for inspection shall be made 24 hr�. in ativance- phone 259•88�S. m'� <br /> N <br /> 2. All work shall be performed in accorda�ce wilh this permit and current City ol Everett Design and Const«ir,tinn O r <br /> Standards and Specifications. c� m <br /> 9. Call Loca�ion Untlergrountl Service 48 hrs. before you dig.TOLL FREE NUMBER 1-SOO•A24•5555. � m � <br /> z t� <br /> ,/� �r <br /> / • /L"� �� �09�Si/L"!/GT�� �F.E' .f�/�/''a'C'°�E(J O A <br /> �CF=�.c<: t��9T�0 �}-/G' -�! .i <br /> � <br /> a <br /> z <br /> � � <br /> � <br /> O N <br /> 2 <br /> O <br /> --1 <br /> a � <br /> m <br />( ACKNOINLEDG[M[NT OF GONDITIONS <br /> The undercigned owner/�pplicant hereby agrees to hold and save.`.arm� <br />� -- less fhe Ciry o1 Evr.rett Irom arry and all claims tor damagea, wsts. <br /> / eKpenses, or cau;es ol action Ihat may arise because of insta�6�fion <br /> <_���� s/p� and maintenance of lhe improvement or other right-ol-way use hereto <br /> , � `� aDPlied for and luriher agrees b remove same upon nofice Irom the <br />� Apprnved lor Cons uction Date City and to repla ublic U�operty damaged thereby. <br />�` _.�.���-�d6 ,� - R <br /> NAL WSPECTION Date t�"�"�- � s �", � <br /> �uP�oved as Gonstructed iglra ol��ca Date <br /> evereu PUBLIC WORKS DEPARTMENT WORK AUTHORIZED F3V THIS PERId1T MUST BE STARTED WITHIN <br /> � 3200 CeUar S!reet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> [verett,WA 98�01 BE DILIGENTLY PURSUED TO COMPLETIOt1 THIS PE5M1T MAV B�� <br /> Phone: 259-881� CANGELL[D BV THE CITY UPON ANY STOPPAGE OF WORK ON T���S <br /> PROJECT OVFR 90 DAYS DURATION. <br />