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Date 3� �G v�ei�wo,wsa�,m�iD• �_6 7/� <br /> Apptication For eieg.oeoi.__�• � S <br /> PUB�.IC WORKS PE�l4�I �T '°°;oWFa�`°� S <br /> Less AOOL Feo PaN 5� <br /> Balance�oe $ �O—� <br /> Print or Type Only — <br /> 355-1Co � <br /> R . A/>� 1 1„n�t�'�) �` L�D7 SF P„rieN-iN�Nl.rin , \u�fe a` 7 ��;e�a/f� �r/A 9:F��d�/ _ <br /> Ownei Mailing Address Cit 7.ip Phone <br /> Sa �,wv. <br /> Applicant �7ailing Address City Zip f-�hone <br /> i <br /> Descn'oeProposedVJork __r ��n �D'� .<<�(�'�� -_— . --_ <br /> — ly�+ r�+ R r��r�xe.-- — --- <br /> e <br /> _ ------- � <br /> Project Address(�I known� 7i%3 — .TuN1PF_.2 •i, � <br /> Attach four(4)cepies o�plans lor propose�.'1 work- Draw lo scale and note the tollowing as applicable: •� <br /> • Property Lines • Centerline of slreet �lA <br /> • Outline and dimensi,:��s of all existing and • Indicate Norih V� <br /> p�oposed structures �.m the lot • Show any proposed grading chenges <br /> • Erisling and proposeo utili!ie[ Y Show measuremenis � <br /> I <br /> � DO NOT WRITE BELOW THIS LINE � <br /> PERMI?CONDITIONS <br /> t. All calls tor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perbrmed in zccordance with this Vermlt and curr,nl City of Everett Design and Construction <br /> Slandards ar,d Specitications. <br /> 3. Call Location Undernround Seraice 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> � <br /> �w <br /> �/ <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> .����: The undersiyned owner/applicant hereby a9rees to hold anC savc harm- <br /> less ihe City ol [verett Irom any xnd all clairns for dam^i�es, costs, <br /> �� expenses or causes of action th3t may arise because ol installation <br /> ?� � /f and mainier.ance of the improvement or other rir,ht-of�way us�� her�tu <br /> �'JPBfli� _� apP�ied for and lurther a�Jrees to remove same upon notice f,om O�c <br /> Approved lor Con uction � �a�e City and to�place�{wblic F'�Pd:tY���'a ed,1hereby. <br /> n /f % � <br /> 1 /.�l"^1�,Y7��/V„C'L i g / 8�g� �`� C �" ��.— � .23 or;'� <br /> FIhAL INSPECTI N i \� Date -- <br /> Appro��ed as Consiructed 1J Sign of Applicant � , Date <br /> evere[t PUBLIC WORKS DEPARTMENT W AU7HORIZED BY I191S PERMIT MUST BE STARTED WITHIV <br /> 180 DAYS OF OATE PERIdIT IS ISSUED AND TF'EREAFTEF IS TO <br /> � 3200 Cedar Sireet 6E DILIGENTLY PURSUEU TO COMPL[�ION. Tiil'i PFRMIT htA1' BE <br /> Everutt.WA 98201 CANCELLED BY THE CITY UPOIJ ANY STOPPAGf_OF WORK ON TiiIS <br /> Phone: 2;9�f3816 PROJECT OVER 90 DAYS JURATION. <br />