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� <br /> Date� u 1 P�o�,�wo��. , �(7Z � i <br /> Application For B�OB Deot . (.���SJ� . <br /> PUBLIC; WORKS P�RMIT �ubTc�'W`���ee g - I, <br /> ISssAn�l feePaia S <br /> Print or Type Only B.�a��.e��� s .��� � <br /> o.k��Y���a3t� i� � �I LZ`1PC':�.C�J�C� A-V� ��� ��#T `�8�.61 _ <br /> pW�e� I.�aii�ng Atldra,s C�ty Zip Phone I, <br /> ��'�� <br /> Apphcani Mailmg Address Ci1y 2ip Phone I <br /> '��C'� �1C� I <br /> Descnbe Proposed Work — <br /> /� - /�,'� W <br /> Pwlect Address lif knorvn� �7�5— C.�LBv � . � <br /> ACach tour 141 copies ol p�ans lor proposed work- Draw lo scale and note ihe lollowing as app��cab�e: �� <br /> • Property Lines • Centerline ol street � , <br /> • Outlme and dimensions ol all existing and • Indicale Norih <br /> proposee�tructures on ihe lot • Show any proposed grading chan9es <br /> • Existmg and proposed utihties • Show measurements � <br /> DO NOT WRITE BEIOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.PJI calls for inspection shall be made 74 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with ihis permit and w«ent City of Everelt Desig�and Construction <br /> Standards and Specifications. . <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-R00•424-5555. � <br /> �� ���,�_,� . ���n�c�. CL'LtG� �C�-L-�� Q.,��i�.�� '- � 'I <br /> /� � � ii <br /> 2 " ps G'P�9a- /� c-1�ez `� O�- ° 2�/uc..z/<.�� � <br /> ,S�C.t.Z��.ex 9 .Ce'� 2L'.t/lii,f✓ �7�u-�ze�>'ue..1i� . � ; <br /> �/ � , <br /> , ,. �I <br /> � � ' � � �C)z-2�c'�t.� ���i-' J� O II <br /> S CZ,/>�ec-xi .� /1!/��iw2e� /r-� _ <br /> / 6 � � <br /> ,���.,,u�� .�c�: S�u�e� r. G /�,,..: s,�r. .r� r: .�.� � <br /> I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicaM hereby agrees to hold and s.ve harm� i <br /> less Ihe City ot Everett from any and all claims lor Aamages, costs, �I <br /> , expenses, or causes of ac�ion Ihal may arise because ol inslallation I <br /> � „ and mainlenance ol the improvement or other nghl�obway use heieto <br /> �%^�'-�� /� �� `�- -�L a ' d lo� and fu th ayrees to remove same upon notice Irom Ihe <br /> ApProved lor ConsiruCtio Date Cily an to ep uUlic property damaged thereby. I <br /> � I <br /> �� /D-�1-�1=� �I <br /> FINAL INSPECTION Dale ^ '� <br /> Approved as Construcled Sig lure of Ap icant Date <br /> WORK �1UiH IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLIG WORKS DEPARTMENT iB0 DAYS OF ATE PERMIT IS ISSUED AND THEFEAFiER �S TO <br /> � 3200CedarStreel B[ DILIP[NTLY PURSUED TO COMPLETION. THIS P[RMIT M�Y BF � <br /> Eve�elt,WA 99201 CANCELLED BY THE CITV UPON ANY STOP°AGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAVS DURA710N. I <br /> i <br />