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% <br /> C3fB��¢� a�oi��wo,ksa�,m��i, (�� <br /> Apphcation For <br /> Bi�9 DeOt a_�6—_J���_ <br /> PUBLIC iNC►RF+:S PERMIT P°°�°WO1k3FeC — <br /> Totel Fce � <br /> Less Appl Fee P�i� $ <br /> Bal:mcP Ouu .'i ���O� <br /> Frirt or Type Only <br /> ('17U.DPr� Si CNiAn 7��4 �PG'��nP/' �A�/: �/ �1/p/21� �'��11� �S ��7 ���.fi <br /> Owner Mailing Address y Zip Phone <br /> � l ✓� Pr <br /> App ieant Mailinc�Address City Zip Phone <br /> DescribeProposedWork __��AJ jiY1R 'P i'drMr �l/ /� '���� LO�I�Ni- ���L _ <br /> -- p- --_ W <br /> Project 4ddre55(il known) _�(� — �./L/�/f�_.� .rJ_l_ _ � <br /> Atlz�ch lour(4) copies of plans lor propwed work- Draw to scale anA note�he following as aPplicable�, � <br /> • Propert5' Lines • Centerline o�sireet ♦A <br /> • Outline and dimensions ol all eaisting and • ;ndicate �:oith V� <br /> nropused structures on the lot Y Show any proposed gradin;� ch;�nge�. <br /> M _aieting and proposed utilities • Sho�.v measuremenf� � <br /> e� <br /> DO NOT WRITE BF.LOW THIS LINF O <br /> -ERMH'f;f7tVL�TfGYJ <br /> t.All calls Ior ins�ection shall be made 2a tus.i vance-phone 259-8810. <br /> hnH-ka-pedermed� � anc=wilh this p�rmit and current Ciry of Evr,re�t Design and Consiruction � <br /> Standards and Specificztions. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NU118ER S•$00•424-5555. � <br /> `-� � K��P s�.ccr� c�c,c'—A-� A <br /> r . g�� C��U� � c�s 1 s��-w��K w��_ �F ��ace� v <br /> � —Il-4-C-' S�-�S �ik�otJ o�2 F'Uf3 WKS � �'_SPEC7o�.r �"' <br /> ii/♦ <br /> �/�► <br /> I.V <br /> i�CKNOWLEDGEMENT OF CGNDITIONS <br /> The uni�rre,iqned owner/applicant hereby ayrees to hold and save hnrm- <br /> --- --- -'-" less the City of Everett Irom any and all claiins for damages, costs. <br /> �����'))) expenses, or causes of aclion that may arise because of inslallation <br /> �_� '��l/�C�/Z..J � /J� ,�n and maintenance ot lhe improvement or other ri�hPof-xay use herem <br /> �� �� � applied lor and further agrees �o remcve same upon notice from the <br /> Appiove �fD Consiruelu�n � '7/ �e City and to replace public proUert/y damaged ihereby. <br /> �/ �/ � / � � �� ��/`4 p <br /> �' % � ; ?/ .� ./G� _ ✓�l'��K'/�/I V 'l/`7/i�� Z/�/�iC' <br /> .� <br /> FINA'I 'PECTION � Date <br /> Approved as Constructed Signa!ure of Ppplicant D te <br /> IVOFK AUTHORIZED BY TNIS PERMIT MUST BE STARTED JJITH!�J <br /> everett PUBLICWORKSDEPAR7MEN7 1g0 C�AVS OF DATE PERMIT IS ISSUED AND ThIEREAFTEH IS 'Q <br /> � ;1200Ceda�Street BE DILIGENTLY PURSUED TO COMPt_ETIOW. 7HIS PERMIT I."f,Y RC <br /> [veretL WA 9820� CANCELLED BY THE CITY UPGN .4NY STOPPAGE OF WORK GN 1 FiIS <br /> P-one�.259�8�370 PROJECTOVER90 DAYS C�UR`•-ICN <br />