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Dete��"�� rn / v�eu<won.va� u. r <br /> Applicatlon For emo.oep� •��(Li— <br /> PUBLIC WORKS PEf�lVIIT rueTo�IFeeFee , _ <br /> lese�p0� Fex PnIA S_ <br /> Ba'+nca Due s <br /> Print or Type Only - — <br /> �er��r ��`1 ,/MEllin�dre s`Jul l � City Cj Zip , � Phon�� <br /> ��3�22_1�.�. S .���-i11�q�:� ��g �N�-3�39 <br /> Applicent Mellinfl Add�esa Clly 21P Phone <br /> Descrlbe Propoaed Work __11„l�LLI �����nU(Cf�Y��� � <br /> W <br /> Prolect Address(il known) �.� � � <br /> Atlach lour(A�copies ot plans lo�pro�oeed work• Drew to scale end nole tha lollowing es appliceble: � <br /> • Properly Llnea • Centerline ol atreet � <br /> • Outline end dimenelons of el!exlating entl • Indlcele Norlh <br /> propoaed etructurns on the lot • Show eny prcpoeed g�ading chenges <br /> • Exlslinp end proposed utillties • Show measuremenls � <br /> DO NOT Wh'ITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells lor Inepeclion shall be mecle 24 hra. In advence-phone 259•8815. � <br /> 2. All work ehall be performad in acco�dance with this permit end current Clly of Everett Design end Construcllon <br /> Stenderda end Specificatlona. <br /> 3. Call Locatlon Underg�ound Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �U/.�G�G [t1o/�.t:5 F'F,n �•>.�; ' ,yCi" -C''RG�/.�E�L7 `3/o�a'7 O <br /> /�� � <br /> � <br /> O <br /> a <br /> ACKNO'.NLEDGEMENT OF CONDITIONS <br /> The undersigned owner/aUPlicanl hereby agrees�o hold end eave harm- <br /> Ir.ss Ihe City al Eve�etl Irom eny end eil clelms lor damages, cos�s, <br /> expenses, or ceuaes of action Ihat may erise because ol Installation <br /> and meintenence o1 Ihe Improvament o�other righl�ol�wey use hereto <br /> epplied for end lurlher egrees to remove eame upon notice Irom the <br /> 4pproved for Conslructlon Dete Ciry end to replece public propeAy demaBed theroby. <br /> �INAL INSPECTION Dnte <br /> iyroved ea ConsUuctad Signetwe of ApGlicent Dele <br /> �erett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERIdIT MUST BE STARTED WITHIN <br /> � 3200 Cedar S�roel 180 DAVS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPIETION. TNIS PERMIT MAV BE <br /> Phone� 259�8815 CANCELLED BY TfiE CITY UPON ANY STOPPAGE OF WORK OIJ THIS <br /> � PROJECT OVER 00 DAYS DURATION. <br />