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� � � <br /> H <br /> Ca, N <br /> ty � y ' <br /> H 'S Date��� ` a�oi���vo,�:a�,m�i, <br /> K (Hj Application Fo� eiaq oea�.. �/ �__G'�f��� <br /> � _ . .., � <br /> � H � PUBLIC VUORKS PERMIT °�����w�«SFeC <br /> ro�a�F�� s <br /> V1 H <br /> � x r Less Appl.Pee Pai� $ <br /> yd Print or Type Only e��a�=a o�� s <br /> OH <br /> H �g <br /> t4'-+` " �.crtP�� f/pss 1817 L!5`st�arnP G/ni�lf 48zd/ �Sa ' �SaB' <br /> Z y� Owner Mailing Address City Zip Phone <br /> E �y a3�-9a6 <br /> ��y uut��, /'o�rt 7H r //02/ 7 -(/� '� 1`f NL` La/�nJ'�v�ur 98dS� a <br /> C ty� Applicant IAailing Address City Zip Phone <br /> Z yO(/� Describe Proposed Work l�n �"i� <br /> Proiecl Atldress lif known) ( �� � �(2W1_���✓-� � <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street /^ <br /> • Outline and dimensions ol all existing and • Indicate North V� <br /> proposed structures on Ihe lot • Show any proposed 9rading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 0�1 1,All calls for inspection riiail be matle 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall he peAormed in accoitlance with this permit and current City of Evere�t Design and Constroction <br /> 1 ' Standards and Specilications. <br /> � 3.Call Loca�ion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 1' - .. /l��/y�.e. Cc'C2l-'�- ��.l.n u.���8-� �c'�,�j�(�r.�r..<��' 1I <br /> � b <br /> 1 1 �:/f'�-/,;_ V� <br /> �_I / ; �—�i <br /> _I LL <br /> ►' <br /> �I� ACKNOWLEDGEMENT OF CONDITIONS <br /> 1 The undersic�ned ownedapplicant hereby agrees to holtl and save harm- <br /> less Ihe City of Everett Irom any and all claims lor damages, custs, <br /> � ezpenses, or causes of action that may arise because ol installation <br /> and maintenance of lhe improvement or other right-oFway use hereto <br /> applied lor and lurthar agrees to remove same upon no�ice Irom ihe <br /> � - APP�oved for Construction Date City and to replace public property damayed thereby. <br /> FINAL INSPECTION Date ; <br /> Approved as Constructed Signature of Applicant Date I <br /> evere[[ PUBLICWORKSDEPARTMENT �NORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> 0 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO i <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLEiION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS II <br /> PROJECT OVER 90 DAYS DURATION. <br />