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k,�..�, <br /> � �� <br /> a <br /> �� � '° Q 91�1(n`� <br /> � � // ^� �. D � V ���'� PivbcWo�bPermil� <br /> � � Date�� �/ _ '` <br /> F�EG.Dent���v� —_ <br /> � � qpplicaf�n For <br /> � � � PUBLIC WOFiKS PERM17" °°°'"'"°'"„°° - <br /> Totel Fex S <br /> p�. b � LcaiROD�Fee�aie 5 -- <br /> r <br /> � �g p o b �,� � � � TO POSTING_—.� � � a.,a��oo�a : � <br /> p„ � Print or Type Onl� , , . . . . <br /> H p� in � •ro om t� <br /> ,.. p-, ,-� w ca r�• m m <br /> 1' H u. .n w .�r CJ <br /> � �y �L/G� /I�r, � � � /�� � �s--� ;� ��i �v�t � �3c�/ .�s�-��� <br /> �y (q �' 1�i�p�'�lddress Cny 2iP Phone <br /> Owner <br /> ��y � o �ac� s =soi.i .+ u <br /> \ O �J J N(K O W � S <br /> [�C \ �� O SC W 6. iil O � tfI .-� U <br /> J ['� <br /> Kl Mail;ng Addmss Ciry ZiP Phone <br /> pplicant <br /> H o vi � �Sl�'�`La �� �l�Gf�u—(i•t-� � <br /> _ `� F <br /> Describe Proposed Work / — <br /> — _�.`� �� r:o rr:.;�c� A`� W <br /> � �e^f�� r,Ln_�_1C[- � /-�J � <br /> Prolec�Adtlress(il knOwn) ---" <br /> � <br /> Attach tour(4)copies ol Plans to�p�oPosed work- Draw to scale and note ihe lollo�ving as apPlicabie: � <br /> • Property Lines • Centedine of streP� <br /> • Outline and dimensions ol all eaisting acd • Indicate North <br /> proposed slructures on ihe lot • Show any proposed gradinc�changes <br /> • Existin�and oroposed utililies • Show measurements /� <br /> W <br /> i DO NOT WRITE BELOW THIS LII'![ O <br /> C�. <br /> i I PERMIT CONDITIONS <br /> t � 1.all calls lor inspection shall be made 24 nrs.in advance•phone 259-BSi O. � <br /> � �� 2.All work shall be pedormed in accordance wilh this permit and current City cf Everett Design and Cr�is�ruction <br /> �, �_—' Slandards and Specilicalions. � <br /> � 3.Call Loca�ion Undorground Service 48 hrs.betore you di�.TOLL FREE NUMBER 1-500•424•5555. <br /> I�� O <br /> I __', <br /> � <br /> � <br /> I �� O <br /> i � ��j � <br /> I <br /> •� n� ACKNOWLEDGEMENT OF CONDITIONS <br /> V <br /> ��'� j The undersi9netl owneUapplicanl hereby agrees to hold and save harm� <br /> less the City ot Evr.rett Imm any antl all claims lor damages. costs, <br /> ezpenses, or causes ol aclion ihat may arise because ol installation <br /> �`1�( /�/1 y and maintenance oi the improvement or ulher righPol�way use hcrclo <br /> r[�D LQ I � IL� �_z/_y' applied 1or and lurlher agroes to remove same upon ootice irom thc <br /> Approved for Construction ���e City anA to replace public pr erty dama�,7ed ihereby. <br /> . �t,fi�� / ���" l/V-'""'"_ _/ �/ / �.c�-�(.X-/� �IL/- /� <br /> FINAL INSPECTION Date Date <br /> ApProved as Consiructed Si�nature of Applicant <br /> WnRK AUTHORIZED BY THIS PERMIT MUST OE STARTED WITHIN . <br /> �J PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 3200CeAurSireet BE DILIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett.WA 90201 CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THiS <br /> Phonc 259�8810 PROJECT OVER�0 DAYS DURATION. <br />