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P„ti�.�,���,.,�,.,, l �J �—y -� <br /> Date , � e,m;i o�oi . �+L�S-�.��� <br /> APPlica�ion For —�_______. _.__- <br /> ro � � PUBLIC WORKS PERMIT �„°'"`"°"'"` 5_ _ <br /> lolalFee <br /> y LcssApplfqrPaAs � OO <br /> �O m e�i,���m„ 5 --L� <br /> C N <br /> � � � Print ur Type Only <br /> o H ro � :,,.. ���1 i� ��7 c�'�,�.�� C�Q�UI���' �.���1"�i1'� -- ,���—`��� <br /> y N �"� �a� Q`v�e1 Maihng Atldress C ty 7� <br /> � H � ��/ //y' �/�.�.�-- �7 P/ 1/1/ ,���� ����Jjj/C1�...2—�-.�•��J �L� (Ii�i,� <br /> �! A�� l �/ L�J[ � l�O�� ����-`�-"""-"- Plionc �C _ <br /> � � � qpplleant Madm9 Address Cdy Zin <br /> yy �_r.���____-_ <br /> M <br /> Ti M <br /> �" i„i y Describe Proposed Work <br /> S N <br /> f] O N �--'--� - <br /> � � " LLI <br /> � <br /> H O N � <br /> Prolect Address 1�1 known� � <br /> � <br /> q����h lou�14�cop�e5 Of plan5lor pwPoSed work� Oraw l0 SCaIC and nole Ihe lollowiny a5 apP�iCable: � <br /> • Property Lines • Centedine af sireet <br /> • Indicate North <br /> • Outline and dimensions ol all ezisting and � Show any proposed grading changes <br /> proposetl 5t�uclu�e5 on�he lot � Show measuremen�E M <br /> • Exisun9 and proposed uiildies W <br /> DO NOT WRITE BELOW TH�S LINE � Q <br /> PERMIT CONDITIONS � <br /> 1.All calls tor inspeceion shall be made 24 hr�.in advance-phone 259•88�0. <br /> 2.All work shall be pertormed in accordance with ihis permil and current Cily of Everett Oesi�n and Construclion <br /> Standards and Specilications. � <br /> i��i+ 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•$555. <br /> � <br /> 1 __ � <br /> �_, <br /> N <br /> -- � <br /> I �-' a <br /> !1�� <br /> �CKNOWLEDGEMLNT OF CONDITIONS <br /> � '�_ The unde�signed owner/applican�heiehy a9rees�o hold and save hann� <br /> less ihe Gty ol Everetl I�om any and all claims for dama9es, costs. <br /> �'�1 ti'y�4 eapenses, or causes ol action ihat may arise 6ecause ol mstallation <br /> —��L�� �2/ /� G y�� and maintenance ol the improvement or other righ4of-way use hereto <br /> �f�.� � applied for and lurthcr agrces to remove same upon notice twm the <br /> Approved I 6onstruct�o6 D le City and to�:�ce pubhc p�opert dama9ed thereby. <br /> � � �l'E`;'`/�%i"�- ��?�9> / <br /> � �_G -�l <br /> FINAL INSFECTIO � ��-���� Datc <br /> ign, rr, ol ApPh anI <br /> qpproved as Conslructed <br /> WORK �UTHORIZED BY TIilS P[RMIT MUST BE STARTED WITIiI <br /> Oeveret� PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISoUEO AND TNEREAFTER IS TO <br /> 3200 Cedar Street BE DILIG[NTIY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt.WA 99201 CANCELLED BY THE CITY UP(�N ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />