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Def2 � '���,��� � � ��,.e�„ w�,�.r�,me. <br /> Applicalion For unia ow� • � ' �' � � — <br /> PUBLIC WORKS PERMIT PueTol�fee`pe s <br /> lafa�oo�Fee Pe�e S <br /> B�i�nce P��r S <br /> Print or Type Only <br /> �Il�ilHnk_/'� ���,� C 'E �)�� �11'�T'�1'( i}�i�� �`��"���� <br /> Owner Mailing Address City Zip Phone <br /> �-������r <br /> � Applicent Malling Address City Zip Phone <br /> 1 yr <br /> Deacrlbe Proposed Work � �-�� � %��� A i - � <br /> �.,�{�j. / J -}� W <br /> Pro�ectAddressplknown� . mlli�l'�+� �'�"���I ( � ��5��� ��* • � <br /> Altech four(4)coplee ol plxne lor propoeed work• Draw lo scale and note the lollo���n�as applicable: � <br /> • Nroperty Lines • Centerline ol st�eet � <br /> • Outline end Aimansions ol ell ezisting end • Indicate No.th <br /> proposed slructures on ihe lot • Show eny proposed prading chenges <br /> � Exlating and proposed utllitles • Show measuremente � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITION9 <br /> t. AII cells lor InaNecllon ehell be mede 24 hrs In etl••3rce•phone 259•881 5. � <br /> 2. All work ahall ba performed In eccordence with �hla permit ontl current City ol Everett Design and Construction <br /> Stendarde end Specilicetlona <br /> 3. Call Location UnAerground Servica 48 hre.belore you dig.TOLL FREE NUMBER 1•800•4a4•5555. � <br /> �� ) � ,y� ._/�. / 7 <br /> !—L��i-Ci <c.%nz��- /-"-.t'.�u.�' !�(a> �t�,c�cc�cl'� �7 lb'/8 O <br /> /�' <br /> <,f ./ � <br /> r <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The widersignnd owner/epplicant hereby nBreea to hold and save harm- <br /> - less ihe City ol Everett Irom eny end dll cleims lor damages, cosls, <br /> ezpenses, or causes oi action that mey arise becauSe ol installetion <br /> ond mamtenance ol the improvemenl or olhe� right�obwxy uae herelo <br /> applied for end furlher egrees to remove same upon notice Irom ihe <br /> I Approved lor Construction Oate City nnd to replace public property dnmaped Ihere6y. <br />�I FINAI. INSPECTION Da�e <br /> IApproved as Constructed Signature ol HppOcanl Date <br />� YVPfP�� PUBLIC WORKS DEPARTMENT WORK AUTIIORIZ[D BY TII!S PEPMIT MUSi BE STARTED WITHIN <br /> 3200Ceder5lreet 1B0 DAVS OF DATE PERMIT IS ISSUE� AND THEREAFTEFl IS TO <br />� � BE DILIGENTLV PURSUED TO COMPIETION. THIS PFRMIT MAY BE <br /> EveretL WA 98201 CANCELLED BV THE GITV UPON ANY STOPPAGE Of WORK ON THIS <br />�� Phone: 259�BB15 PROJECT OVER 90 DAVS DURAIIUN <br />