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��� <br />m�x <br />C", H <br />�Htn <br />y�H <br />�y� <br />M H'� <br />[/� H <br />�O� <br />H t7 <br />OH�y <br />H C��7O <br />�V n <br />�H� <br />HH <br />gN <br />H <br />CC] C7 V� <br />C7 � M <br />z H �n <br />HOCA <br />p" ,.. <br />i �-�. <br />e �_ <br />Date__ <br />Application For <br />P4JPLIC W�R6CS PE�MlT <br />Print or TYpe Only <br />aueuc wone Permlt • �j <br />9i0a.0eo�• ��/���'" � <br />Fvbec Wo�s Fao S <br />rotai F.e <br />Leea AoO� Fan Paid S <br />eam��a o�e 5 <br />Address City Zip �hone <br />Descri6e Praposed Work <br />TI / S>�S �� _. <br />Prolec[ �.ddress (�� known) � � " `'� '-' - <br />Attach four (41 copies of Plans for proposed work - �raw to scale and note � Cy^�,e`�1n�of �p,pe���le: <br />O PropehY Lines • Indicate North <br />• Ou�line antl dimensions of all exisNng and � Show any proposPtl n:atling changes <br />pmposed structures on lhe lot � • Show measurements <br />• Existing and p�oposed utilities <br />- __ --s�w <br />L <br />PEflMIT CONDITIONS <br />t. All calls tor inspection sha�l Ce made 2a hrs. in advance- phone 259-8810. <br />2. All work shall be peAormed in accordance wilh this permit and current Ciry of Everert Casign anC Construction <br />Standards and SpecificaUons. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE 17UMBER'I •800•424•5555. <br />(� �,�I�-z. A�.IU�� �' � ��t 1 �� <br />�'�1z Iti--- <br />�-z�z �-��1 <br />Approved �or ConStfuC�iOn �ale <br />FINAL INSPEC710N Date <br />AppfOvetl as CUnS[NCted <br />�PUBLIC WORHS DEPARTMENT <br />�� 32C0 Cedar Street <br />w�`�A Everett. WA 98201 <br />�a� Pho�C:259-8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The underslgned owner/app�icant hereby ag�ees to hold and save harm- <br />less Ihe City of everett fmm any and all claims tor damages costs. <br />expenses, or causes oi action that may ari;e bewuse of in;tallation <br />antl mainlenance of the improvement or other rign4ohway use hereto <br />applied for and further agrees to remove same upon notice from the <br />City antl Io replaCe public O�operty damagea thereby. <br />Signature of Applicant �a�e <br />WORK .iUTHOFIZED BY 'HIS PERMIT MUST BE STARTED WITF'IN <br />180 DAYS OF DATE PERMIT IS ISSUED .1ND THEREl.�TER Iy TC <br />BE OILIGENTLY PUNSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANGELLED BY THE CITY UPON ANY STOPPAGE JF Vi::RK ON THIS <br />PROJECT OVER 90 �AYS OURATION. <br />