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� <br /> `.;.- � ���,,,:Wa,�=P�, 8 8 — 33 3 <br /> Date �� ����',�� <br /> � 6 � <br /> �' Bm0 DZPt� � <br /> qpplica�ian For <br /> PUBLI� VISORhCS 9�Ef�MIT P°°"`"'Ofk5F0e — <br /> Tolal Fee � <br /> Less A00��Fee PaiO $ <br /> Oalance0ue �. "��'�� <br /> Print or Type Only <br /> e � r � G ��l.F� �L� l'� '�I � �_ <br /> —���.�'��'/�, I�� �����V�( � .�� i � JC ��> ���� <br /> ���y�E� MailingAddress Ci�y Zip Phone (�Yy� ��� <br /> I <br /> ,i- �1� <br /> � <br /> App!ican� Mailing Address City Zip Phone <br /> � <br /> Descrihe Proposed Wark _ ��r� ' <br /> �1 � <br /> Piolec� Ac'�.dress(if known) _!'�`�v —T!i{//�.�K� .Ur� — � <br /> Hit..:h four 14) copies of Flans tor proposed work- D�aw to scale and note the following as applicable: �� <br /> • Property Lines • Cenlerline ol sireel � <br /> • Oulline and dimensions of all existing and • Indicatr, Norih <br /> proposed sirucW res on Ihe lot • Show any proposed gradmc�changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE /I\ <br /> PERMIT CONDITIONS �ar <br /> 1.All calls lor inspection shall be n�ade 24 hrs.in advance-phone 259•8810. � <br /> 2.,111 work shall be pedormed in accordance with ihis permi!and wrrent City of Everet[Desian and Consiruction <br /> Stzndares and Specifications. <br /> 3.Cat!Luc.tior Underground Service n8 hrs.before you dia.TOLL FREE NUMBER 1•80f�-42d•5b55. � <br /> \✓ <br /> � <br /> �/1 <br /> � <br /> tli <br /> P,CKNOW�EDGEMENT OF CGPIDIi IONS <br /> The undersigned owner/applicant herehy agrees to held and sa�R harm� <br /> . � less the City of Everet� from any and all claims for dar-ayes, costs. <br /> /�L,�yIf/ expenses. or causes of action ihzt may arise because ol ins!allah.on <br /> "� ��,.,,,/�,p. and mainlenance ol lhe improvement or other right�o��way use hereto <br /> ""'' "`� ��� 'a8 applied . and tur�l�er agrees �o remove same upon notice irom the <br /> Approv "ipr Cons�r L'l�on . Date Ciiy an � rep�ar.e Fubli 'proper�y damagetl ihereby. <br /> �� ��C ���� 1 � � U / � �— p`� <br /> C /' f�c- / G .�_t.,— `� - I ; . ,�l �!? <br /> FINAL INSP[CTION � �— � Date Uate <br /> Apprnved as Constructed Siy at e ol APPIi6 nt <br /> W{7F1 AUTHORIZED BY THIS PERMIT tdUST BE STARTED WITHiN <br /> ere!ett PUBLICWORKSDEPARTMENT 180� DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStree� I BE DILI�,iENTLY PURSUED TO COAIPLETION. THIS PERMIT b1AV BE <br /> Everett WA98201 CANC[LLED BY THE CITY UPON ANY STOPP�IGE OF\VOF7h'.ON THiS <br /> Phone.259�8810 pROJ`CT OVL(; 90 Dt�l'S DUR�ITION. <br />