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, � � . <br /> � �y � <br /> �,''�'3 VJ Date_-^-�--.1 / a�oi,�v,o,�sa�,m��i. /�-� /���— <br /> H "'F{ D�aB.Oeot.s _— <br /> y H Application For <br /> oxa <br /> PUBLIC Wt�RKS PERMIT °°°To,aFa�FeB 5 <br /> � !/1 H <br /> Less Aoo�.fce Paia S <br /> y z � palancr.Oue $ GQ�Q <br /> �� a Print or Type Only <br /> H t7 <br /> �� g S�tia�� �oo$ r� �b�.� � E� ef�e{{- `157�1 zs5-�7Z� <br /> z y � pwner Maiting Address Ciry ZiP Phone <br /> rHH St1G.�-Z-. �,Uag I-�WL��^'�fi� 1��/�L�'t� I��I ZS��ZZ� <br /> g � Applicant Mailing Address City Zip Phone <br /> H <br /> C� t7 CA <br /> . 1 <br /> [�� �ij DesCribe Proposed Work r0.� � rb.lu �1 L r��- `t�k`�`� �'� � <br /> HOf�i� <br /> W <br /> Project Ac'�ress(if known) Ib ID � °�' �U{r� � <br /> Attach lour(4)copies ol plans lor proposed work- Draw lo scale and note the following as applicable: � <br /> • Properry Lines • Centerline ot street ♦/� <br /> • Outline and dimensions of all existing and e Indicate North V� <br /> proposed structures on tl:c lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /y� <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. q � <br /> '�1 2.All work shall be performed in accordance with fhis permit and wrrent City of Everelt Design and Consiruction ♦ <br /> �� Standards and Specifications. <br /> ' ' 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � � <br /> '�'' S,( �/1«��.�Ja� L<-'.p�� '7rya� [S2 !ixa�`tr(cs ZO � LJ� <br /> 0�� �,v,, .s��2n� "� 307 � <br /> � � � 1 • . ��/ ` /' !Ja c� DYl � <br /> S �1t%(4/nirJy GJRG/" s�usf Ge .$'P� GGL/. T/tlh'� /w <br /> � I � ' <br /> _ , / L � <br /> .s/GYL�LtJ[l�� 5 G/�C� '�F.'ri-�Ce�s �.'I^ Q//!< CfK'O� .S�cfC{] � <br /> 'o' n � � � <br /> ! ' � � ,.,��� Ct7�f/ CGt'r neec�S 'fo do 4h� C�nr.E /n �his �iy/,7`'o�- C✓2y <br /> �� ,<J�ea, f�� le�fnininy cuaCl i-�usf be �fctk�h o�own rcf -tbe <br /> O ow�ars �pance, o <br /> ACKNOWLE¢M�D''1E o OF C�DITIONS <br /> The undersigned owner/appSit�r�t he�by agr��s to hold and save harm� <br /> 0� less the Ciry of Everett from �ahy ��id all c{$1ms lor dama9es. costs, <br /> � expenses, or causes of aclion ihaK.�iay arise because of inslallation <br /> � �� � B c�/ and maintenance of Ihe improvement or othen righFul�way use hereto <br /> .�1 - - �- " _- � � applied for and furlher agreos`:]o remove saNe upon notice irom the <br /> A .p oved tor Co ction �- Date City and to replace public p dpe`�ty damaged=fiiereby. <br /> ( � ��vv'„'"` <br /> o c� <br /> �.,fC��� 6-.�G -1 L �r�j ^"i � <br /> FINAL INSPECTION Date <br /> Approved as ConsVucted Signalure of Applicant � Date <br /> � PUBLICWONKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MU'�uT BE STARTED WITHIN <br /> ,v� 320CCedarSireet 1B0 DAYS OF DATE PERMIT IS ISSUED 'A{JD THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY B[ <br /> CANCELLED BY THE CITY UPON ANY STOPpAGE OF WORK ON THIS <br /> Phone:259-0810 PROJ[CT OVER 90 DAYS DURATION. <br />