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�ate� b'7 <br />Applicaticn For <br />PI��LI� V1lAR�S PERIV�IT <br />Print �r Type Only <br />Owne� , Mailirg <br />Pvµ�, �, � c «,f�er/ <br />v,n��� wm�s �,,,�n�i a _ CJ �' �� <br />FiU4 Dept • <br />PuOLCWo�kSPee 5 <br />Tolal Fac <br />L¢Ss ApPL Fec 4 aid � <br />,S�O <br />Baiance Due �Y __ � — <br />City Zip Pnone _ <br />s3�� 3s �y <br />SaMc `�LLo GoL /a- c �vc%��f"r.��<k `lf��-�J ii/o�P - <br />Applicant ^� NailingAdAres City Zip Phone <br />Describe Proposed Wu�h _[.�}fJ�Lf.LL o�t! /I, t� / n-v� i�v �� i a v � v c.v�� <br />�v.tc-Zsi--.���C�LGEi� f39Y.r/ly _ -- <br />ProlPCt hddress �ii k�.�own) <br />Attach tour (4) copies ot plans lor proposed wuk - Draw to scale and note the following as apflicahle: <br />• Property Lines <br />• Outlinr. and dimensions ol all existing and <br />proposed SVuctures on the lot <br />• Existira and proposed u(ilitie�s <br />lor <br />PERMIT CONDITIONS <br />• Genterline of street <br />• IndiCa�e Norhti <br />• Si�ow any proposed grading changes <br />► Show measuremon;e <br />h!I wlls lor inspection shall be made 24 hrs. in advance - phone 259•88? 5. <br />PII vrork shall be perlormed in accordence wilh this permit and curren� City of Everett Design and Construcfon <br />Sandards and Specifications. <br />Call Location Underyround Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />'`� �l�,E� T �"E- [�o.�/E' .pF,�� �7�i',e��� F�� <br />,r�r� f,'tJ..t/rf ,�}.r?.-•'L.7 / j �'-/o' �r, <br />� -- <br />as CcnsiruGed <br />everen PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 9ffi01 <br />Phonc:259�8d75 <br />Giii6/B., ... ,-'"t ' <br />C�;;l;��, �..0 <br />����L[.I� .��J.l�l! <br />AChNOWLE9GEMENT OF CONDITIONS <br />7he unticrsigned oKner/applicant heraby agrees to hold and save harm- <br />- less the Gly ol Eve�etl Irom any a�id all c�aims for damages, costs. <br />ezpenses. or causes ot action �hat may arisr bacause of installatinn <br />�s 5,y and mainlenance cf the improveme it or otl�er righFnbHay use herelo <br />applieA for and furiher agrees to re,rove same dF�n notice Irom ihe <br />, Date �ity and to replace public property daroc�ed !here6y. <br />i ,, /� ` <br />'✓tDa� �t�� Y/i - �/' �' -��r.� '�� ' l <br />7/ � <br />Signalura ol Appfic Date <br />WORK AUTHGRI2E0 BY THIS PER�NIT MUST BE ST.4RTFD WITHIN <br />18� DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEii IS TO <br />BF DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH: CITY UPON ANY STO�PAGE OF WORk ON TYIS <br />PROJECT OVER 00 DAYS DURATION. <br />