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i }� �; -- <br /> � Date i[—".I—�34 � ` - ' a�oi��w�,k:Pe,mna �� I <br /> Applicztion For eiaa o���.y LGSb 1 ��. <br /> I PUBLIC WORKS PFR �,T � °°��°W°�k=Fee <br /> I'i � �.� �OSTING �i < � T'iaiFce �5 — <br /> . Less aooi.Fee Paia 5 , <br /> Balauccoue $ <br /> Print or Type Only <br /> 3ohn C "arU.c 141?! 57th 1ve NF Nai:vcvillr Pd271 fi59-557J otr �!iQ-t.11-"':14 r•;r. 306 <br /> � Owner Mailing Atldress City Lip Phone � , <br /> � Ovner � . � .� . <br /> ' Applicant Mailing Address City 2ip Phone '� <br /> I Describe Proposed Work new� }:ou�c _ _ '�, <br /> � <br /> _ � . <br /> Project Address(it known� 74^_1 JunlpeT lli __ L �, <br /> , r <br /> . Attach lour(4)copies ot plans lur proposed work- Oraw to scale antl note Ihe fol,�winc�as applie.ahle�. � <br /> • Properry Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate Norih N � <br /> �� proposed structures on ihe lot • Show any proposed grading ch2nges �i <br /> � • Existing and proposed utilitir,s • Show measurements Y '� <br /> � Yir <br /> DO NOT WRITE BELOW THIS LINE o I <br /> ' PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � �� <br /> '� 2.All work shall be performed in accordanca with this permit and current City of Everett Design and Construction <br /> , Standarjs and Specificationa � <br /> �� 3.Call LocaBon Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800-h245555. � . <br /> ' � !ii � �ii,...i vtl�..�i �. Jn. ���. .. .���, •� �..f�n_ lu.rt.l i�r .Ip.. _:) u�. h�.nr., il�:� �r� I l�l�lp��� , � � i.- ...� <br /> � . �{i�"!i �u;l'.�i{I �iP�� �S: , �.III�ii! �. •.�f': LD�.fr� ii�i nnr.t �. �:t 11.:1�7i'�'fm.� I.P��Lir . . � tU{. O . <br /> � '. <br /> N I. <br /> � O � <br /> a � <br /> . ,; <br /> � AGKNOWLEDGEMENT OF CONDITIONS I <br /> � - The undersigned owner/applicant here�y agrees to hold and save harm� ! <br /> less Ihe City of Everet� Irom any and all claims for damages, wsts, <br /> � e•<penses, or causes of action that may arise because of installation <br /> � i and maintenance of the improvement or other right-of-way use hereto <br /> �'��� !� � � /����� �� �� � applied for and further agrees to remove same upon notice from the , <br /> Approv r Conslruc;ion n Date City and to replace puClic property damaged Ihereby. <br /> � <br /> �� ,�-/L/_ �'-Io -9 ---�- - _ <br /> FINAL INSPECTION Date ' ` '� � <br /> Approved as ConsVucted �gna(ure of Applicant Date <br /> V✓ORK AUTHORIZED BY THIS PERMIT MUST BE START�D WITHIN <br /> PUBLICWORKS�EPARTMENT � 1B0 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> 3200CedarStreet - BE DILIGENTLY PURSUED TO COMPLETIOM. THIS PERMIT MAY BE <br /> Everett,WA J8201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT 9VER 90 DAYS DURATION. <br /> 7 <br />