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Date�!`5� U I � v�m��w�,kaae,m�i. <br /> AppliCation For � eica oam-+ � � `� 7�� <br /> RUBLIC �fM1/�RKS PEI�MIT PuoTottlFe�Fee s - <br /> �ess aom.Fee aeie S — <br /> Belenceoue S <br /> Print or Type Only — <br /> )�1'lS C.��rt;� c�`1�.� �Ac�so,J ��ei2� �" :�.5�=/J-7c .3 <br /> Owner MaJing Address City Zip Phone <br /> \ <br /> h'`�_— <br /> Ap;�llcant Mailing Address City Zip Phone <br /> I � � <br /> Describe Proposed WorY. _�" ���-11 — <br /> Prolect Address(it known) __SZ�—1sJLV-- \ ��'� � <br /> � <br /> Atlach four(4)copies of plars lor propused work- Draw lo scale and note the following as applicable: � <br /> • Property Lines • Centerline ol slreet /^ <br /> • OuUine and d�mensions of all existing and i Indicate North �� <br /> p�oposed�tructures cn the lot 7 Show ary proposed grading changeo <br /> • Existing and proposed utilities • Show measurements �q <br /> Mr <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 7. All calts fm inspection shall be maae 24 hrs. in advance� phone 259-881 Ei � <br /> 2. All work shall be pertoimed in accortlance with ihis permil and current City o`Everett Design and Construction <br /> Standards and Specificalions. <br /> 3. Call Location Undergrou�d Service 48 h�s. belar�you diq.TOLL FR-EE NUMHER 1•A00•424•5555. � <br /> �pr �., , '� � <br /> /L � „ kS <br /> (/;,t �� `�� � �f ` �t �i4�� �w <br /> 1 Y/ <br /> � 0 .-1� �. <br /> .� �.� <br /> ry�— � �- � � <br /> SPw�-: � I �-e��-� or � a <br /> � `� <br /> Z � �� ;.�� o <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereEy agrees to hold anG save harm� <br /> less ihe City ol Everell Irom any and all slaims Icr damages, cos�s, <br /> expenses, or causee ol action ihat may arise Ueca�se of mstallatiun <br /> and maintenanre ol ihe improvement or uther iighbof�way use hereto <br /> applied tor and lurther agrees to remove samc upon notice from the <br /> Approved lor Construclicn ���e City and to replace public properry damaged the:eUy. <br /> FINAL INSPECTION Dale — -- <br /> Appcoved as Constructed Siynalure ol Applican� Date <br /> � WORK AUTHORIZEU BY THIS PERMIT MUST BE STP.RTED WITHiN <br /> everett PUBLIC WOAKS DEFARTMENT 180 UAVS OF DATE PERId1T IS ISSUEO AND THEREAFTER IS 70 <br /> � 3200 Cedar SL•eet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAIIT MAY BC <br /> Everett, WA 98201 CANC[LLED �V TNF CITY UFON ANY STOPPAGE OF WORK ON TkPS <br /> Phone: e59�9815 PROJECT JVER :�0 DAVS DURATION. <br /> � <br /> F � � <br /> � <br />