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��� 8a - ��i <br /> Date Pubbc Worhs Pr�m�t , �� <br /> ApplicationFor eia9.o�r�., ; � <br /> 1' <br /> PUBL�C WORKS PERIVIIT � °°W°«°F°° <br /> To�r�F�a s <br /> Lrtss ApPI Fon Pa�a $�_ <br /> BalanceUue S 2p¢ <br /> Print or Type Only <br /> ���lil�� �� �L1�J._J.���"C�{ti1J���i� �=� ;�/F'-�- �R�n I �,a-�.b <br /> Owner Mailing Address ! City Zip Phone <br /> � Applica� Mailing Address City Zip Phone <br /> Describe Proposed Work �� `� �� I � ��� '����� � <br /> � C``(-- � �F� ���� � <br /> W <br /> Prolect Address Iil known) yG3p � C�--Po.Pi 4�G. � <br /> Ur <br /> Attach four(4�copies ol plans lor proposetl work- Draw to scale and note the following as applicable: �� <br /> • Property Lines • Centerline ol sireel � <br /> 7 OuUine and dimensions of all eri^,tiny and • Indicate Noith <br /> proposed sVUCtureg on the lot � Show any proposed yrading change, <br /> • Existing and proposed utilities • Show measuremen�s � <br /> ' DO NOT WRITE BELOW THIS LINF O <br /> PERMIT CONDITIONS <br /> i.All calls tor fnspeclion shell be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit 2nd current Ciry of Everett Design:.nd Conslruction <br /> Standards an�Specifications. <br /> 3.Call Location Underground Service 49 hrs.befure you dig.TOLL FREE NUMBER 1-800•�524•555�. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACI<NOWLECG[MENT OF CONDIT�ONS <br /> The undersicned owner/appli,;ant hereby ac�rees to huld and savc harm- <br /> -- - Ir,ss ihe City ot Everetl Irom any and all claims lor damac�es, costs, <br /> / expenses, or causes ol action that may arise hecause of installation <br /> 1 `� � _ _ �!_ 2 8g and maintenance of Ihe impiovement or other rigM-ot�way use hereto <br /> 2G OaJ"" ap �ed �n. �nd luriher agrees to remove ame upon notice Irom the <br /> Approved for Constru on ate Ci � nd to repL•ice public prop ly tlamag�� ihereby. <br /> / i <br /> FINAL INSPECTION � ��� Date � U�`�� / { � �/l � ��j <br /> d <br /> Approved as Constructed Si nature ol Applicant T D� <br /> everett PUBLIC WOHKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF OATE PERMIT IS ISSUFC 4ND THEREAFTER IS TO <br /> � 3200 Cudar Street BE DILIGENTLY PURSUED TO COMPLFTION. 7HIS PERMI7 MAY BC <br /> Everelt WA 9F201 CANCELLED BY THE CITY UPON ANY SiOPFAGE Of WORK ON THIS <br /> Ph�ne:259-8810 PROJECT OV[R 9G DAYS DURFTION. <br />