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A �o <br /> Dates��o�O I PuObc WOrks Parmit• �� G � - <br /> �r ��G �� <br /> 4pplication For aiae oeni.+�T � <br /> PJBLIC WORKS PERtiVIIT '°°Ta�aF�e`p� s <br /> �ossnoa��-o P.,�o S <br /> s Zd p.✓ <br /> 6e�e�ca ov�: <br /> Print or Type Only -- <br /> o�,,.� etl-.i)i�e. /ya9 /,3raa� .�r. , _�a�th� ��`�l aS� -L/�aGc— <br /> Owner Mailing Address City Zip Phone <br /> �G Qrn.�n���t� 5:�27 �z9�tiA�e �E ,fneharv,ir{, 9�d4D 5�0� 4��_ <br /> Applicant Madin�ddress Ci�y ZiP �P one <br /> Describe Proposed Work <br /> L ,l_�.ae�,lltL�_.�ba�-�,�°1a � <br /> - W <br /> ProlectAddress(ilknownl 7�32 ' �LF'��vUv � <br /> Attach four(4)copies of plans lor proposed work• Oraw to scaie and note the following as applicable: � <br /> • Property Lines • Centerlinc of sireet � <br /> • Outline and dimensions of ail existing and • Indicate Norih <br /> proposed structur..s on the lot • Show any proposed grading chanyes <br /> • Existing and proposed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONUITIONS <br /> t. All calls tor inspection sh�d be made 24 hrs. in advance- phone 259•P31 5. � <br /> 2. All work shail be nerformed in accordance with this permit nnd currer Jiry of Everett Design and Construction <br /> Slandards and Specifications. <br /> 3 Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBE!7 1-800•424•5555. � <br /> / O <br /> I n �� H <br /> /, l�� 6����°� � xP5 ♦A <br /> (9 rr D �I� <br /> �r3L w � s� O <br /> Se �� �-�oc:�S � <br /> �'��� �° c� <br /> , <br /> ,(\_ — ACKNOWLEDGEMENT OF CONDITIONS <br /> ( �s <br /> The imdersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett Irom aoy and all daims for damages, wsts, <br /> // expenses, or causes ol aclion that may arise because oi inslallation <br /> �i'�(/= / ��z� ��j��e and mainlenance o' Ihe improvement or other right�ol�waY use herelo <br /> ���iL•� upplied for and funher agrees lo remove same upon notice Irom the <br /> Approved tor Constru�on � ��a�E City and to replace public . perty damaged thereby. <br /> �_ l�-�C� �G� fG ./�/-.Z�-��o <br /> FIN INSPECTION Date ' Date <br /> Approved as Constructed S' nat re o Applicant <br /> W R AUTHORIZED BY THIS PERMIT tiIUST BE STARTED WITHIN <br /> r.vcrett PUBLIC WORKS DEPARTMENT 7g AYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 320G Codar Street BE DILIGENTLY PURSUED TO COMPLETION. iHIS PERM�T MAY BE <br /> Everetl.WA qII�01 CANCELIED B'!THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVEr�90 DAYS DURATION. <br />