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C] � �0 f r��e��„e:�nsr�, , �__ - <br /> ttl y <br /> �o m Date `+ I(D � n��:: o�„� a _�T—�-`�-`� ' <br /> H � � ApPlicalion For --- <br /> KS P E R M IT °"°"`"'°""�a s--- <br /> PUBLIC W�� T�"��eC <br /> �ese Ao01.Fcc Vaef S <br /> � � � 9alancc D�o S _ <br /> N H <br /> � � � Prinl or Type Only <br /> co s�' H� S�A e 9��� ��!d'-S�sa <br /> Zin Phone <br /> M <br /> M � � � Ji. i `Q! S c��v <br /> � ~ Owner MaiVing Address — <br /> N <br /> N <br /> � N N Zip Phone <br /> j p y �� Mailing Address City <br /> C ApPliwm <br /> � �H N <br /> H O N <br /> Describe Proposed Work <br /> � W <br /> �n..9 C� �-I C fL�q���2� � <br /> prpject Addres5lil knowN �� <br /> Ntach�our(4)copies o�plans lor proposeA work-D�aw to scale and no���Centedine ol stree�ablr. � <br /> • Property Lines • Indicate Norih <br /> • Outline and dimensions ol all ezisting and � S��o,h,a�Y proposed gradin9 changes � <br /> pwposed s�ructures on Ihe bt • Show measuremeNs <br /> • Existing and proposed ulilities <br /> ,--� DO NOT WRITE BELOW THIS LW[ O <br /> I �� pERMITCONDITIONS � <br /> 1.All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•881�. <br /> � 2.All w�rk shall be pedormed in accordance wilh ihis permit and current Ciry of Everett Design and Construction � <br /> I '�_ Slandards and Specilications. <br /> _ 1 3.Call Lowlion Underground Servicc 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•555 . <br /> _ O <br /> I �� ��lo P�r3�� � (..le,�. �s Y� �.r��r Ke�vi���u �... <br /> �=i -z.6- yo V/ <br /> __ <br /> �.�- ��`-`�-` O <br /> � � <br /> a <br /> � <br /> _e_� <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> The undcisip��ed owner/app�icant he:eby a9rees lo holtl and_,�n�:�'•+r°'� <br /> �� � less ihe Glly oi Everett Irom any and all claims lor domc�nc:�. �°s�`� <br /> � <br /> expenses, or causes of action thal may arise becausc of msicdl�t�o❑ <br /> and maiNenance al the improvement or other iigM�ol�way usc �������� <br /> Date City''an�d to eplace1publ c9peoPer�yrdamaqed tlherehy.n notice ho�» ����' <br /> Approved br Conslruction <br /> � Date <br /> FINAL INSPECTION Signalurc al ApPlicant <br /> qpproved as Consiructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> Oeveicll PUBLIG WORKS DEPARTMENT gE DI�LIGENOTLY�PURSUED 70ICOMPLETION.DTH SEPERMIT MAY BE <br /> 3200 Cedar Street CANC[LLED BY TH[CITY UPON ANY STOFPAGE OF WORK ON THIS <br /> Everell.WA 98201 <br /> Phona 259�8810 PROJECT OVGR 90 DAYS DURATI . <br />