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Date�`� ^ ,' �q.{�� 'ZT <br /> / � � PUM¢WoA�nermil t � `" � <br /> ,.-7 , ,CT."_�_ <br /> Applicali0n Po� 1 Blop Oeo� • <br /> PlJBLIC WORKS PERMIT � P�°;o;;�s��°a , - <br /> ' lefa�on�Fee Pua S <br /> Frint oi Type Only B�hnce Due s 2G"—'� <br /> / I '/Ull/�l�) :Z-.`�• /� <br /> ( ����i �/�'(l. �����G/'_) ._�r �. �� ��`1. / /'�/5h�'�� li���r/ -C.J✓r/lJ <br /> Owner eiling Address Clty � Phone <br /> y`��/��/t'"i-� <br /> Appllcent Mailing Address City , Zip Phone <br /> Desc�ibe Proposed Work _ 1 Y.I.� ,� ` '�- k, ��T� � �'� �c�, ���� C_�"�C'�� <br /> Pro�ecl Address;if known) _��� 7 ^ CA.SCf7��r' �.�". � <br /> Attach lour(4)cople�ol plens lor proposed work- Drow to scale and note the inllowing as applicable: � � <br /> • Property Linae � Centerline of slreet � <br /> •Outline end dimenalons ol all exiating end • Ind�cate North <br /> proposed Stnicturee on the lot • Show any proposed grading changes <br /> • Existing and propoaed utllitles • Show measuremenis � <br /> DO NOT WRITE BELOW THl,ri LINE <br /> PERMiT CON�ITIONS <br /> � � 1. All cnlis lor inapacllon shall be mede 24 hrs.In advance• phone 259•881 5. �' I <br /> 2. All work shell be performed��acco�danca wilh this permil end cwrent City ol Everell Design and Consiruction � <br /> Stenderds and Specifications. � <br /> 3. Call Location Undorground Service 48 hrs belore you dip.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> /�� I <br /> V♦ i <br /> O <br /> a <br /> � <br /> ACKNOWLEDGEIdENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to��old and seve harm• I <br /> less the Ci�y oi Everetl trom any and ell cleims lor dameges, costs, � <br /> � . . �� ezpenses, or causes oi action that may a�ise because ol Installatlon i <br /> -,,� end maintenance o Ihe improvement or other righPol-way use he�et0 I <br /> ' -li-/?��`� '� '�'��- ��?-� � �� gpplied for nnd lur her agrees lo remove seme upon notice Irom the <br /> Approved lor Constru�ion Oete Cit nd to replac <br /> y� public property damaged thereby. , � � <br /> FINAL INSPECTION Date � �l Nr///�III��� IL/IFI�_ <br /> App�oved as Conshuctnd glgnatur�pC p�i ^� �je�o - <br /> everett PUBLI�WORKS DEFARTMENT WORK A� ORI�ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 C��tlar Sirce! 180 DAY F DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> �veratt,WA 98201 BE DILIG N LY PUFSUED TO COMPLflTION. THIS PERMIT MAV BE � <br /> Phone: 259-8815 CANCELL BY THE CITV UPON ANY SipPPAGE OF WORK ON THIS <br /> PROJECT CVER 90 DAYS DUFATION. <br />