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Date�-10 � �. ' �/ - <br /> PubLc WoiFs Per s �/J <br /> ApplicationFor � ema�oco�.• ��.'�.� <br /> P'UBLIC WORKS �'ERM �T P°°.o,aFeaF�� $ -- <br /> 0 <br /> � Less Aoo�.Fec Pa�a $ <br /> n n o - <br /> � � � a aa�a�«o�o s 35�° <br /> Print or Type Only d r,, ,,, �„ — <br /> w ui <br /> �' m .-� <br /> � � <br /> ; ��Tr �v�-rnr�-z��� � �� � s� � Vc,ce ��cx� _ <br /> � pwner MaiVing Addre.� o � p CityW Zip Phone <br /> i � <br /> � � n a � u <br /> 0 0= � <br /> ! t�� � �I �— <br /> ! Applicant Maif dress . City Zip Phone <br /> I <br /> � Describe Proposed Work /�—� � ��(JI [r�/I /'�.f�61� � f�V�7C4�--'J <br /> i <br /> ' W <br /> { /D2�3- � .- _ 1� <br /> Project Address(il known) <br /> r <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Properry Lines • Centerline ol sireel � <br /> • Outline and dimension5 of all existing and • �ndicale Norih <br /> pro,osed structures on the lot • Shnw any proposed grading changes <br /> • Existing And proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordsnce with this permit and currert Ciry of Everett Design and Construction <br /> Standards and Specificati�ns. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> / J-CCY.Ci/xJ ' i[[� /.t¢. .Lrta[�+-'U��' �Pi1. Cc�f cf Gfi�P/Lc� O <br /> SCCv+—d�RiLC✓l �j�j ��Z 9 l00/' . � �� / C <br /> J'. �1-LC'.II/ �1a�0 !'�PCl/2.G1�2 ff iCC�[,yfl7l-/ /fl 11C� O'O».¢/ � <br /> � ��"�. �,����� a-s`90 , �a��J a-�'ac.�e�� � <br /> �, �� C'c,.f�" S'�it:e�-z� �a� c�' a�/�>Ln� _ O <br /> a <br /> ACKNnWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt Irom any and all claims tor damages, costs. <br /> � � expenses, or causes ol act:on that may arise because ot installation <br /> �.��'�!/l/C= /�� �� /a and maintenance ot ihe imProvemenl or other righPohwaY use hereto <br /> applied for and further ag�ees lo remove same upon notice Iwm ihe <br /> Approved f (Consiruc�i n ' Date Ciry and to replace public property damaged Ihereby. <br /> �c� :�/'��(� � � ' �` � <br /> FIN�AL INSPEGTI � � - Date � �! �� ��•YI `C <br /> Approved as Constructed i ature pplicant —� Date <br /> everet[ PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED BY THIS PERh11T MUST BE STARTED WITHIN <br /> � 3200CedarSireet 780 DAYS OF DA7E P[RMIT IS ISSUED AND 7HEREAF7ER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br /> Phane:259�8810 CP.NCELLED EY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />