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' l, / � C�c- � '��—�"- � auoi�c wo,.:rermn. .��/�7 7 � i. <br /> Da;_ � � <br /> j �� aiag.000�._ !. <br /> Application For � <br /> �C� PUBLIC WORKS P�RililiT �y Publ¢WorkiFee 5 ,�,�.;� ��- <br /> Toiai Fee <br /> a y Less Pool.Fee Pa0 5�—�J-- <br /> la�`� 6alanco0ue $, ��^l� <br /> a yx� Prin; or Type Only <br /> H 93 <br /> y zH C <br /> � F3� � '�-c�-�l I ��2�?-t �� �L'�1'• G.4(`I 7�til��'�cC �NCG`��NUII�L. 1 i�r� ,.��CQ i 1 ��/��1( <br /> � �,x„�� Owner • MaiVing Address Gry Zip Phone <br /> y H <br /> y z C�1 <br /> 1iME f�� i\(�w h= <br /> � y Cy Applicant Mailing Adtlress Ciq� Zip Phone <br /> OH <br /> H �g __ ' ` -- <br /> �. O Des":6e PraPosed Work 1-�1"T-�_I�� \ �,�.--r� �_I r-1� �7 ""^ .�'.'1�1�.���i^1..= d.. ��1 .'1 !ii ._ e�.�.�--+'L <br /> � y� '`F�� - — <br /> z <br /> 1�� <br /> •' � <br /> • r <br /> � �� F" <br /> r Pro;e:tAddresslifknown) • '� �'�� (.�% ��''�_ �_r ��lflll . <br /> [t1 <br /> 2 H� Atta:i'our(4)coP�es ol Plans lor proposed work-Draw lo scale antl note the tollowing as applicable: � <br /> y �y • Pmperry Lines • Centerl�ne of street ♦^ <br /> - • Outline and tlimensions of all existing and • Indicate Norih V� <br /> propasetl structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposeA o�i6fies • Show measurements � <br /> DO NOT WRITE BELOW iH15 LINE � <br /> PER�d1T CONDITIONS <br /> ��r t. All calls tor inspection shall be made 2d hrs in atlrance� phone 259-881 5. <br /> �� 2. All work shall be performetl ir accordance wdh ihis permrt antl current City of Everett Design and ConSlrucLon � <br /> Stantlartls and Specdications <br /> 3. Call Location Untlergrountl Service 48 hrs. belore you d�, TOL�FREE NUMBER 1•800•424•5555. � <br /> ��_ / : <br /> .�`.s �1. n—?N �'-���'.�ic�.,.� rl /�!lZ7�<< . O <br /> •' � <br /> � � � <br /> � �.:� Y/ <br /> � <br /> � � <br /> '='i ACKNO�VLEDGEMENT OF CONDITIONS <br /> The unAersigned Owner/appliC�nt hefeby�g'ees t0 hold and Save harm- <br /> less thc City ol Everetl Irom any and all claims tor tlamages. cosis, <br /> �� _ . ezpenses. or causes of action Ihat may arise because ol instaltation <br /> ��� and maiNewncc of tne�+mprovement or other right�ol�way use hereto <br /> • !:���=- �� � � �'�, �`'�� applied �o� an� funner agreec'W remove same upon notice from the <br /> Appro�ad for Constiuction Date City and to replace pul>lic ;�mo�rry dam;iged Ihereby. <br /> 9�z5 �87 J` � p � �'I <br /> FINAL NSPECTI ���C Date ll`1,1 ,(�lIILP� �• `ICtitA-t-- I? �tJ�-G-Sfc <br /> Appre�.etl as Consiruc�etl Si9nature qf Applicant Date <br /> WORK AUTHORIZED BY Tl11S PERMIT MUST BE STARTED WITHIfJ <br /> evr.�eit PUBLIC WORKS DEPARTMLNT 1g0 DAYS OP DATF� PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUFD TO COMPLFTI�N.THIS PERMIT N,AY BE <br /> Everett WA 98201 CANCEi_LED BY THE CITY UPON ANV STOPPAGE UF WORK ON THIS <br /> Phone: 259��815 PROJECT OVER 90 DA'f5 DUFATION. <br />