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��� <br />m�x <br />C H <br />9Hfn <br />i <br />H � <br />�H� <br />�Hhi <br />y H <br />H <br />`Z <br />OHd�y <br />H^ l'��JO <br />y,V � <br />9H� <br />�h+H <br />gy <br />�e� <br />� � i�l <br />zyw <br />H O p! <br />I +d �`' <br />�I <br />' �� <br />a � <br />, _ _�_. <br />__. _ ._ _.�.�:_�.. <br />.. _.._ _ _ __ _ __ _ _ __ _ _ _ . . .. ,��,,,� ..�._,._.. <br />, Y.. Y �..:<� <br />Py��lm WU�FS Pe�mil s <br />Date q'•; a 71 - <br />eia9 Deo�� • <br />Apf•lir,2�ion For _ __ _ <br />�UBLtC WOF�KS PECiMIT '°°°`"'°`"="a _ <br />roim Fc� 5 <br />Les's nopl Fcc P�ia S <br />� � Erianr,c om S — . <br />� Print or Type Only <br />� ; . �.. <br />! <br />Appucant <br />Describe Pruposed Wo�k <br />Adtlre55 <br />f / f} <br />71/��+ f <br />Mailinn Address <br />��U ,, r- T, � <br />T <br />���'7 <br /><' "%� � �. '"!/li! /}!�� .'r (- L <br />Zip Phone <br />_ ,��_., <br />�. <br />Zip Phone <br />Proler.� Addresslif known; � � � �� � �-- ` ���"�--- -� <br />Attach four In) copies of plans tor proposetl work � Draw to sc�le antl note thn followin9 as apPlicable: <br />s Properry Lines o Centerline of street <br />• Outline and dimensions o� all existin9 anA •{ndicate North <br />proposed slrucWres on �he lot t� Shuw any aroposed grading changes <br />• Exishng and proposed u�ilities S Show measuremeMs <br />� PERMITCONDITIONR <br />�� i. All cal!s for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />� 2. All work shall be pedormed in accordance with this permit and curent City ol Everett Dzsi�n ar�d Gonstruction <br />� Slandards and Speci(ications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOI.L FREE NUMBER 1•800•424•5555. <br />I <br />f� :`, __� , ;. . . �: . . �� - - r . <br />��.-: �,-,-,�==:., <br />�,.- = <br />�!' /. f'r� <br />,... <br />�.+�._< a.•. <br />�:':. <br />Approved lor Construction Datc <br />FIfJAL INSPECTION Da�e <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3700 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hcreby agrees to hold and save harm- <br />less ihe City of Everetl Irom any and all claims for damages, costs, <br />ezpenses. or causes of action that may arise because of installation <br />anA maintenance of Ihe improvemenl or other ri,r,hFof-way use herelo <br />applir.d (or and Wrlher agrees to remove same upon notice Irom ihe <br />City and to replace public pwperty damaged ihereby. <br />Si9natureolApplicant � Date <br />WORK AUTHGRIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANC7 THEREAFTER IS TO <br />BE OILIGENTLV PURSU[D TO COMPLETION. THIS PEFiMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />