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Date���� ���,��.wo,�sP�,m,�, rJ�'`/ 8G_V <br /> Applir.ation For E���n oepi + �'�l� -�1 <br /> PUBLIC WORKS PERMIT `�°°°°w°°=`c� --- -- <br /> ,��,�F�� S--- <br /> t��ssann� Feeaam 5 --- <br /> ��VOO <br /> eai.,�«o��, 5 <br /> Print or Type Only — <br /> m�xF <br /> � <br /> ��^,M� CL�.��,7 '��`��'�'a"S (�-�� 5� �� �V'�� Y�1'�''�111 1 � <br /> Owner ' MaiNngAddress Gty Zip � Phone <br /> ;�w�._� . — `��3 ��i'l��) <br /> qpphcant Mailin�AdAress City Zip Phone <br /> �escribe Proposed Work �� ��+—W �L-/.�� ' ' `-^ `---II� <br /> —_— — � <br /> Protect Adtlress Iil knownl ���'�— �«��'J-���n � <br /> / <br /> Attach lour(41 copii �,oi plans for proposed work- Draw to scale and note the�ollowing as appl.cahle: � <br /> • Property Lines • Centerline of street ♦^ <br /> • �utline and dimensions ol all ezisling and • Indicatc Nonh V� <br /> proposetl siruciures on ihe lot • Show any proposed grading changes <br /> e Existmg and proposed u1i!ities • Show measurem=�ls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFMIi CONDITIONS <br /> t.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this perrnit and current Gity of Everett Design and Conslruction <br /> S�andards and Specificalions. <br /> 3.Call Location Underground Service 48 hrs.bztore you dig.TOLL FREE NUMBEP 1-800•424•F555. � <br /> `I, TN� APPL�GANi Sf/FJLG 13� P�Gj(Ji.�BU Tv �'omPc_T<.-�y O <br /> 1��EPLAG� A•vy Si DEWllt K � CUPd ANO CrU7TEil' B/ZUK,�i`� <br /> ��' Df3MH(�ED vU�'-��U GvNSTQtIG%ioN DF 7NiS HuUSE, � <br /> 5� TNc APGGiLANT SNAGC Ba �PcJPvNciBGF c� %h'E Co� YY <br /> �o �C'cf�i•c' TN� G<JATE,E' S'j�uT- OF� �i� Tia.S Lc�T /{ O <br /> a:c�!_'civ ���,��„v'C. coNs7,:vc;;cn.�. <br /> a <br /> ACKNOIh'L[OG[MENT OF CONDITIONS <br /> Thr undersigned owner/applicant hereby agrees�o hold anA save harm- <br /> � less Ihe Gi1y of Everett frnm any and all claims for �i2ma9es, costs. <br /> �_/Ry � � � expenses. or causes ol action that may arise because of installaion <br /> �N ` �^ ���,� / �vcia� and maintenance ol Ihe improvement or other rightroFway use hereto <br /> �.�� U���� —��� appiied lor and Wrther a9rees to remove sam: upon notice Irom the <br /> Approved f��sirucl�o •'^ i �1 �1tl�� City and to replace pubhc property damaged Ih;reby. <br /> � /%� f // �/ <br /> , l� c / � /`/�Z�����r�-'-L'%�� / �/J� <br /> FINALINSPECTION � bate -�� /`f � �D <br /> ��Provetl �s Coi�structed Signature ol AnPlicant Date <br /> WOAK AU1�iORIZED BY TIiIS PERMIT MUST BE STARTFD WITHIN <br /> eveirtt PUBLiC�:ORK�DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> � 320�GedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA1' BE <br /> Everelt,WA 3A201 GANCELLED BY THE CITY UPON ANY STOPP.4GE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVflR 90 DAYS DURATION. <br />