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/ ✓ <br /> � � � <br /> O�� Date_l�� ���i,i��w��w:rc,m�i. _ U o?� <br /> eiao.owi.• <br /> Q y Application For <br /> y� � PUBt !C WORKS PERMIT Pu�TolwFcaFee S � <br /> K� n Less Appl Foo Pnid $ � <br /> ��� o,�,���o�e s y�'s— <br /> Print or Type Only <br /> ��z z'�2 �O� I <br /> e _CAsT�o� ��Uf��'71GS i414 ��SCP�`U���31r- �EAtT�'� `14�ID� <br /> M�g Owner Mailing Address Ciry Zip Phone <br /> p. C� <br /> �y� ��., v� yAA �� �, �' � . <br /> Applicant Mailing Address City Zip Phone i <br /> FF <br /> uQp�,p Describe ProPosed Work T� �����,`—��� ���'��/`iJ//�� �� <br /> PI�" � ��,� / �I <br /> W <br /> �� W � <br /> , <br /> Projecl Address(if known) "� � Z� �L �0�4 P �� � "� T � �i <br /> Attach lour(4�copies oi plans tor proposed work- Draw to scale and note the lollowing as applicable: � ' <br /> • PropertY Lines . • Centerline of streel ♦A <br /> • Outline and dimensions ol all existiny and • Indicate Norlh V� <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> i' � 00 NOT WRITE BELOW THIS LINE <br /> IC PERAiIT CONDITIONS O I <br /> � j � 1. All calls lor inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 1 ' 2. All work shall be perlormed in accordanc� with this permit and wrrent City ol Everett Desi9n and Construction <br /> '�_ . S:andards and Specilications � <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> +' � �S ��.C'o��'- �7 �'� <br /> ; y_ ��_,� � �,� � � ��� O I <br /> I -- � i <br /> , �__ � <br /> --' O <br /> , o_�_� a <br /> ACKNOWL[DGEMENT OF CONDITIONS <br /> =1� <br /> � ThQ undersi�ned owner/apP'icant hereby agrees to hold and savo harm- ' <br /> Iess the Cily of Everett Irom any and all claims for damages, cosls, �II <br /> expenses, or causes of action ihat may arise Uecause ot inslallation <br /> p/ nd maintenance ol the improvement or other right-ol�way use herelo �, <br /> � � applied for and furt ac�rees to remove same upon notice irom the I <br /> qpp oyGdJo/C�p tructio " . � , � ,��/ �"�- �� j � Ci1y and to repla ic property damaged ihereby. �il <br /> �/ j � < <br /> / �� � Q�� � _/ /)�� J �L./ $ � <br /> FINAL WS CTION � � ` � " � �Dalc <br /> ApProved as Constructed i9na ure ol Applic nt Dale <br /> everett PUBI �C WORKS DEPARTMENT OR AUTHORIZED BY HI P[RMIT MUST BE STARTED WITHIN <br /> 0 3200 Cedar Slreet 18 AYS OF DATE PERfiM IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS OURATION. <br /> i <br /> I � . <br />