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--�,!:2=�� � ,. 3 � 3Z � <br /> Date r , � pr, vJ � o„n�Kwo,..,.,,m�. <br /> Appiication f or h �� � � e�ao nem. <br /> PUBLIC WORKS PERMI� P�mKwoa.�e� <br /> .e,.�F�� s <br /> L!a�11pp1 Fx PeiE s <br /> Print or Type Only e.�a�uo�� {_.35�° <br /> �l,z—.�Z 2 S�O//s 3/ <br /> '� d—"`� ' � d �2.5�a ��� l - ✓��e l r - /��' <br /> Owner r Malting ddrese City Zfp (I G� G� ph , �� <br /> %D �� v <br /> S�t� Mailing Address City Zip Phone <br /> Describe Proposed Work �.r]� :� n i: !'���' � <br /> Project Address(i1 known) _ (� � /l� (J � V�' � <br /> . Attech tour(4)copies oi plana for proposed work- Draw to scale anA neta the loilowing as applicable: � <br /> • Property Lines • Center�ine o1 street � <br /> • Outline and dimensions of all e:.isting and • Indicate North <br /> p�oposed structures on the lot • Show any proposed grading changes <br /> • ERisting and proposed utilities • Show measurements � <br /> 00 NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shell Ge made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shell be portormed in accordance with this permit and current City of Everett Design and Constructlon <br /> Standard6 end Specifice�ions. <br /> 3.Call Locetion Underground Service 48 hrs.belore yeu dig.TOLL FREE NUMBER 7•800-4345555. � <br /> /, CUD,G� %O ,8F- ,DO�/� piz�L' P[ANJ' APo�e�%vo:D o,�/ �9/Y-� O <br /> �U�oy° 4�a�G%ed, <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMEhT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> — less the City of Everett irom any and all daims for damages, cosfs. <br /> �:� I[i�f�s�a�L. ,�9/f,j exDenses. or causes of action that may arise because of installation <br /> and mainlenance of the improvemenl or other nght-oFN�ay use he�eto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approved for Cor�i tructio� Date City and to repl e public property damaged by. <br /> r-Y- y a <br /> FINAL INSPECTION Date � <br /> Approved as Constructed Sig ature ol pplicant ate <br /> � PUBLIC WORKS DEPARTMENT WORK AUT ORIZED BY THIS PERMIT U5T BE STARTED WITHIN <br /> 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone:259-eB10 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS OUFATION. <br />