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.. <br /> -� <br /> Date�t�3 PuElic Work�Parmll� 7�Z <br /> i <br /> Applicatlon For ema.o.o��• <br /> PUBUC WORKS PERMIT FuUrc�.mbFe� � <br /> Lu�Nppl Re P�IE � <br /> Print or Type Only e.�.��.o�. t y�- �� <br /> '�'1�3� y 'B <br /> —S�i��� .�)�;✓', � �o.�l.x ,�iLS �,uen�✓� c7)z . /��'o7y �?L8��3 <br /> Owne� Melling—A7dreas City Zip Phone <br /> ri ��� ���.._. <br /> Applicent Mellinp Adtlreas City 21p Phone <br /> Deacribe Propoead Work �n � `t�/'//� ^w ��• ��'"�,� �� � ��+1� /n�� . <br /> W <br /> Pro�ect Addresa 111 known) � <br /> Atlech lour(4)coplus ol piens lor proposed work• Draw to acele and nola thn I011owing ae eppllcable: � <br /> • Property linee • Centsrline of street � <br /> •Outline enA dir�enelone ol ell eKletlnB end • Indicate Norlh <br /> propoeeo st��cturee on the lot • Show eny proposed preding chanpee <br /> • E�,uallnp end proposed utllltica • Show measwements � <br /> DO NOT WHITE BELOW THIS LINE O <br /> PERMIT(;ONDITIONS <br /> 1. All calls lor Inapection ahall be mede 24 hrs. In advence-phone 259•681 5. � <br /> 2. All work shetl be performed In eccordence wlth thls permlt and current City ol Everett Desipn and Conetructlon <br /> Standards end Specllicatlona <br /> 3. Cell Locetlon Untlerpiaund Servlce 48 hra.belore you dlp.TOLL FREE NUMBER 1•800•424•SSSb. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undeielgnod ownor/epplicent hereby eprees to hold end eava herm• <br /> lese the City oi Everett Irom any end ell ctalme lor damaqee, coat& <br /> expeneas, or causes of actlon thet mey arlae becauee of Inetellatlon <br /> '� �,�^� /���t, ��_ � . �.-S end melntenence of the Improvemenl or other ripht•o4wey uee hereto <br /> � � epplietl for end lurther epreea to remove eame uDon notice Irom the <br /> Appr'o�ed for C natruction Date City en-i lo replece public property demeged thereby. <br /> �[•� l'�l; � //, n <br /> FINAL INSPECTION � De�e 'L��� � �/' ' �I •- ��'�� S <br /> App�oved es Construc ed Slgna ure ol Applicant � Oele <br /> everett PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED BY THIS PERMIT MU3T BE STARTED WITHIN <br /> � 3200CadarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br /> Phone:258•8815 CANCELLED BY THE CITY UPON ANV STOPPAQE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br /> 1 <br /> 1 <br />