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� <br /> � _ - __. �- __- <br /> ' Date ��' l.� � �*`°i P�o�,�wo,�,Po,m <br /> AC.�lication Fo� � o�aa oeoi . . —� �� <br /> PUBLIC WORKS PERMIT P�^���w�«,��� - <br /> ,o�a���� s <br /> �ossaoni�cr Pai� 5 <br /> ��'b � PriM or Type Only e.,�.,�«•o,� s <br /> A`.0'.�yC � 1 <br /> �-si Hr�y I �.� �1F�f! �t_.��� ( �1 ��� � C^ri �/� ����� !'A�� C � `'`i�� � -2��� <br /> y ?H ��, Owner Madmg Adtlress Cily Zip Phone <br /> Z <br /> � H� <br /> � �� i ApPlican� MailingAtltlress Cdy Zip Phone <br /> � �p� I Descnbe ProPosed Work /�M f'�/� ��^�� ( � ��(�/C / <br /> H C7 <br /> � �g I , _ <br /> y�Y � <br /> �tttyyy y� I Proiect Addresslil known) ��' / (-�y �� I� � _ � <br /> � d y li Attach lour(4)copies ol plans lor pmposed work� Draw to scale and note the lollowing as applicable: � <br /> � <br /> • Property Lines • Centerline ot sireel � <br /> � I • Outline and dimensions ol all ezisling and • Indicale North <br /> yHO� i proposed 5tructure5 on Ihe lot • Show any proposetl 9radinc�change5 <br /> • Ezisting and proposetl ulilities • Show measwements � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> I <br /> PERMITCONDITIONS <br /> 1.A�I calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> i 2.All work shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specilications. <br /> �� 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � � <br /> i-<:,_.�a L. �lc��: r�vr��Z- t�1cTr C�c���z�v <br /> 1�j `�a.�..._� �Y1� �Cv� � <br /> �`_ -� p _ ,�C� � <br /> 1` � — _ _ 'A <br /> �� �I V♦ <br /> I O <br /> -� a <br /> � <br /> ��; � <br /> � <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby agrees to hold and save harm� <br /> � less the City of Everelt Irom �ny and all clalms lor dama es. costs. <br /> f'�I' i expenses. or causes ol action that may arise oecause ol irnstallation <br /> i and mainlenance ol ihe improvement or olher nghFoi-way use hereto <br /> ! applied for and lurther ac�rees to remove same upon notice ��om Ihe <br /> � Approved lor Consiruction Date Clry and to replace puhhc properry damaged Ihereby. <br /> II FINFL INSPECTION Date _ <br /> IApProvetl as Consirucled Signature ol Applicanl Date <br /> . everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT IdUST BE STAFTED WITHIN <br /> ' � 3200Cetlar5lreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.Wa 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT h1AV BE <br /> � Phone:259�8810 CANCELLED BY THE CIT1'UPON ANY STOPPAGE OF WORK ON THIS <br /> IPROJECT OVER 90 DAYS DUFATION. <br />