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��� <br />� <br />p C <br />C N <br />b H N <br />. <br />H n <br />K y �� <br />��ip M �V <br />N F+ <br />� H � <br />O M <br />z n o <br />Hca� <br />c� - <br />H <br />N <br />H <br />N �3 <br />O N <br />14 <br />O N <br />�� M <br />O N <br />� � � , <br />I ' 1 <br />+ s <br />�— _. <br />► --� <br />��1't <br />o,i�.2��,_'% <br />qpplication For <br />plJBLIC WORKS <br />Print or Type Only <br />i, ��..\•.,,....rr�mil• .._. --... ' __ <br />����� o,.,,� . —2a,�'�%.Y— – <br />P E R M IT I�"°"` w°", `a" §_ — <br />Tolnl Fen <br />LeSa POC�� Fae Vn�d 5-� <br />n.�ience0uo ��� <br />A., __" �:� � Pi�onc <br />pddress ���y <br />De-cribe Proposed Work <br />p,oicct Address 1'il knuwn) <br />p,n;,-'� tow 14) coPies ol Plans br PmPosed worM � DraH <br />• Property Lines <br />• Oulline and dimensions ol all ezisting and <br />proposed structures on lhr lot <br />• Existing and proposed utildies <br />to scale and note the foilowing �s apP�icable: <br />• Centerline ol street <br />• Indicale North <br />• Shmv any Proposed 9rading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />i. All calis lor inspeclion shall be made 24 hrs. in advance- Phone 259•88 <br />2. All work shall be pedormed in accordance wilh this permit and current Giry of Everelt Desi9n and Conslruction <br />Slandards and Specilications. <br />3. Call Location Underyround Servic= 40 hrs. belore you dic7. TOLL FREE t7UMBER 1•B00•424•55 . <br />l�l o-4-� b �; c. \�lo� K s��''^� :�I- � c�� ;�-e c <br />�.�- N1��— <br />�-8—�� <br />Dat <br />approved tor Construction <br />Date <br />FINAL INSPECTION <br />qpproced as ConsVucled <br />� PUBLICWORKSDEPARTMENT <br />�i_' � <br />� 3200 Cedar Slreet <br />Everett Wp 96201 <br />Phonc: z59�8810 <br />W <br />1- <br />- <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />7he undersi9ned owner/apPlicant hereby a9�ees to hold and save hanm <br />less ihe City ol EvereU irom any and all daims for damages, costs. <br />eapenses. or causes o� aclinn that may adse because ol installation <br />applied1lor and furthera9rees to r�emove'same upon noUcesfromrt�� <br />City and to replace Pu61ic O�oPertY damagee thereby. <br />Datc <br />Signalure ol APPlitant <br />1VBORDAYS OF DAT�E PERMIT ISESSUED AND THEREAFTER ISfTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED E3Y THE CITY UPON ANY STOPPAGE �F WORK ON THIS <br />PROJECT OVE� �0 DAYS Dl1RA710N. <br />