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/ /1� �/ � �6-ZgL <br /> � Date{�L�'v a0 Pu�i¢Woi4s Parmil• <br /> � / Applicati0n Fof o�ae�D�ni • ���,�T_ <br /> � <br /> � PUBLIC WORKS PERMIT °°°°°W°��,�°° <br /> .o�a�Faa s <br /> �' less Rppl.fae Pnif s _ <br /> Print or Type Only BT„��eo�e s 35 00 — <br /> � <br /> ,. <br /> `tp �� /�a F�.4 7' �.Pod>> J134'� 3�f�'�,��� .�r�ETT�� �/;t� 3,Z�-3q� <br /> C Owner Mailing Adtlress Ciry Zip Phone <br /> ,� <br /> � �No�A�.�L.�I�F' -�tiat�P ..�Ga�arr ,P <br /> qpplican� Idailiny Address City Zip Phone <br /> f ct�1 /9'ola3 <br /> .� Describe Proposed Work �?.rjl�G'C�e�d%��C.q[,� <br /> I �� <br /> i - - W <br /> Pro�xt Adtlress(it known) -.C-[-�✓-�-( � <br /> Attech four(4)copies of plens for proposed work-Oraw to scale and note the lollowing as applicable: � <br /> • P�operty Lines • Centerline ol st�eet � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposed structures on lhe lot • Show any proposed grading changes <br /> � � ExisNng and propo5ed utilities • Show measuremenis � � <br /> i DO NOT WHITE BELOW THIS IINE <br /> PERMIT CONDITIONS O <br /> �� 1. All calls lor inspection shall be made 24 hrs. in advance� phone 259•88�5. � . <br /> i 2. All work shell be perlormed in accordance with Liis permit and wrrent Ciry ol Everett Design antl Construction <br /> � StandarAa nnd Specifications. <br /> � 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> t '/ <br /> � T LlJO.�P.� TO 8E �U�E 19CONG �G C Ey SiD E O <br /> � Of dc�ic,c�iNG mtJS� NoT ����,� AttEf/ <br /> i �Lv/T.s'OdT /�E.Pirs.SS��� ��m THE �bG�CE <br /> q,�/v Fi,PE �F�v�PTmE�/TcJ�. � <br /> O <br /> a <br /> ���� !r�2� f���t-1t-8o35� <br /> /1CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> 'ess the Cdy of Everett Irom any antl all claims lor damages. costs. <br /> ���----��/// oxpenses. or causes ol action that may arise because ol installation <br /> r/_��/QP���f— /�/ /�� and mamtenance ol ihe impwvement or other right�ol�way use hereto <br /> � vl,�t/oi �O �e/ apPlied lor further agrees to remove same upon notice Irom the <br /> Appioved lor Consiructi�a��2n ate Cdy o re ace Public ProPertY damagetl �hereby. <br /> � / <br /> GSG�� /O-,�G -J'6 � ,� ryi <br /> FrNAL INSPECTION Date ��� <br /> Approved as Constructed �gnature ol A;,pllcant Date <br /> everett PUBLIC WORKS DEPARTMENT V/0RK A�,i�HORIZED BY THIS PERMIT MUST E S RTED WITHIN <br /> � 3200 Cedar Street loU UAYS OF DATE PERMIT IS ISSUED AN ?H EAFTER IS TO <br /> Everett,WA 98201 f3E DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 ��ANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />