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D31@��1 � r�ni�-v:a�.�r��.��+���. _ _ <br /> Application For <br /> oi�f� oco� • .F��/pZ�SJ_�_. <br /> PUBLiC WiDRKS PERIVIIT PVeTCITFeeFee � - <br /> LessApplFeePauf $ <br /> e.,�.�„�..u�� 5_ <br /> Pririt or Type Only --- - <br /> ��/ nr�n��J <br /> Owner Mailin9 Address Ciry ZiFi Phone <br /> /� .l ,�n...,., /Q,rn�,ifin� <br /> Applicznt Mailing Address City Zip Phone <br /> Describe Proposed Work i n no n� I M l✓h�9/gf.�y_�_LC'1� �l�n / l� (!!'!� <br /> W <br /> Project addresslif known) _ �(�,'� .— � <br /> AttacY four(4) copies ol plans br proposetl work- Draw to scale and note e lollowing as apphcable � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions ot all existinq and • Indicale Norih <br /> proposed slructures on the lot • Show any proposed g�ading chanyes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CO�DITIONS <br /> 1.All calis for inspection shall be made 24 hre.in advance-phone 259•8810. � �� <br /> ?..All work shall be peAormed in accordance with this permit and current City of Everelt Desi9n and Consiruc�ion <br /> Stnndards and Specifications. <br /> 3.Call Location Underground Service<8 hrs.belore you dig.TOLL FREE NUM�ER 1-80C)•4�24•5555. � <br /> �BG�LC/CC�Cr-C�T,.F/iY+^�'� /+�0� �Cl�C"v'�-�/ (.� r��'�01� O <br /> L ��7-l-� �y� � <br /> � <br /> O <br /> � <br /> ACKNOVJLEDGEMCN-'OF CONDITIONS <br /> Tha undersigned owneUapplicant hereby agrees to huld and saoe harm- <br /> — less ihe City of Everett irom any and all claims lo� damages. cosis. <br /> ezpenses, or causes of action that may anse because ot installation <br /> and maintenance of the improvemenl cr other righbot�way use he:e!o <br /> applied lor and luriher a�rees to remove same upon notice from the <br /> Approved for Conslruclion Date Cily and to replace public property dama9ed thereby. <br /> FINAL INSPECTION Da�e <br /> Approved as Consiructed Signature ol Applir,ant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIi MUBT 8E STARTED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED !•ND THEREAFTER IS TO <br /> � 3200CedarSireet BE DIIIGENTLY PURSUED TO COMPLE��IO`J, THIS P[FiMiT MAY BE <br /> Eveiett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPFNGE OF INORK ON THIS <br /> Phone:259�5870 PROJEGT OVER 90 DAYS DURAI ION. <br />