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�1'�iL"5Y: I <br /> � I <br /> V ! �� <br /> � • <br /> ... _..... ' <br /> G� <br /> }�-/ • ` � T/� pn T I(� .J�� <br /> Date1=L �`..• 1 11 1"l•�l I�V ll._�2`I oe�wo,w,r�im�i. � � , . <br /> Application For eiaq oaoi • <br /> � � PUBLIC WORKS PERMIT P°°,�w°«°�°° ' <br /> ,o�.��e» s <br /> p .� . lesanom reeaa�a S � ' <br /> > H - Batanco Due $ 3S �O <br /> H�n Print or Type Only <br /> � �" �°M� J � �1 '�- �( � <br /> o �o R ; ► l �F �'� +� ���c T�" �7�30 �n u�+�� on�zrP, lUa lda�,� - 7S� � <br /> � <br /> hp y� Owner �Mfa(inyApar�s City Zip Phone <br /> W <br /> � �O� �AmP C.on� ' ;I��( t3�uQrP���c ,�j�0 �F�rl�Gt ���ec��, IV� 9�/ ?��C��� % <br /> O M C7 Applicant ---�+TSR g�'�'�� Gry Zip Phone <br /> ��CQ� � J� - � N- �E � � � I I <br /> `+ Describe�j roposed Work � ����� C � � tt �/ P2 — ��10 �-�pw � JT�` <br /> � H� � ..,S.V Ci '7 r '` ru� "7.F S C �c.l� u -� �X�'—.. <br /> C� <br /> i-+H <br /> � w — <br /> �py� W <br /> � [�y <br /> t" Proiect AGtlress lil known) � v "'�� � ^ _ � <br /> Oy <br /> y Atlach lour 14)copies ol plans lor proposed woik•Draw to scale and noln Ina folbwing as applicable: � <br /> . • Property Lines • Centerline cl street � <br /> • Outline and dimensions of all ezisting and • Intlicato No�th <br /> proposed structures on the lot • Show any propoSeA grading changes <br /> . • Existing and proposed ulilities • Show mezsuremenis � <br /> DO N07 WRITE BELOW THIS LINE O <br /> � � PER'dITCONDITI0N5 I <br /> � � 1.All calls for Inspeclion shall be matle 24 hrs.in advance•phone 259•881�. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Desipn and Consiruction <br /> Slanderds end Specifications. <br /> ',r, � 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> �^ ! r � I <br /> � ,�c � A-%'a� 7`0 �3e do�� P�r a�q.� 4/.�o���e��n O i <br /> �'.3;_ya a fl�> 7'� �c c.,e,�,l.r -, � /f l d� ; <br /> _ _ <br /> y � �-, t <<,�y � �:�,� , <br /> S, A� as-o,(�., or ds��y�c✓Sc��✓uGf� S'l,aLl dc � ' <br /> qs c�r•r.cf�c� L fi,� �F��cea� �/� <br /> ��I 1 f��Gc C�o�,fr jns�ec'/',>r V� <br /> ... • <br /> (�, Gvor,f f� �� p�v��� fi�r'�Ctn.,..� d�f _ZIA �rocCSl � S-9 O <br /> � �.' <br /> (_..`i Conp'ifr.rs. � -, . <br /> .. �' �iu=� C�� Sfr�:efr C < , . <br /> Y �K,� :, :.;1 f,��s <br /> ! � ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned owner/app�icant hereUy agrees to hold and save hann� i � <br /> less the City o� Everetl Irom any and all claims for damages, cosls. ', <br /> �i w eKpenses, or cnuses of action Ihat may arise because oi installation � <br /> '�ff� ��/ and malntenance ol the improvement or other righDobway use herelo <br /> �=�� ---�� npplietl lor antl Luther a9�ees lo remove same upon ootice Irom the <br /> Approve r Cons �:bpf� �7 Date City antl to replace public yroperry damaged Ihereby. - <br /> . F.%' l�-r� 1���' � F C��� ` (� 7 <br /> � <br /> FINAL INSPECTION � � Date � • � �"�`�` � " � �`� � <br /> Approvetl as ConslruCed Signature ol AppLcant Dale I <br /> � PUBLICtYORKSDEPARTMENT WORK AUTIIOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CetlarStreet 180 DA1'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br /> Everett,WA 98201 BE DILIGENTLY PURSUED 70 COMPLE710N.THIS PERMIT MAY BE <br /> Phono:259�9810 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJF.CT OVER 90 UAYS DURAT�ON. <br />