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�8te I�I D PuG�¢Worx�Pe.m ��—36 Z� <br /> Appl!cation For emy.ocni •_ <br /> PUBLIC WORKS PERMIT P�°,o,°«`� : <br /> T� ���Tl�r-_�iT �eat�C0lFeePaiOf� <br /> Print or Type Qnly � � V <br /> ea�ance uue f �� <br /> c+oz -�2 z-yn -�o-ii-�3/ <br /> �i '�'►- A�m-� ��� lLl�U I in,3�2� S _ �� �- 9 R t "1�7 <br /> Owner �_ MaiHng Address �i� — - <br /> Y ZiP Phone <br /> S��- �,[�'1 <br /> Applicant Mailing Address City Zip Phone <br /> Deecribe Proposed Work ( "��p�1 � -71—i.r l( i �J��C, � �n �� <br /> W <br /> Project AAdross(H known) � • • � <br /> Attach tour(4)copiee ot plans t�r propoaed work- Draw to scale and note the following as applicable: � <br /> • Property Linea • Centerline of sireet � <br /> • Gutline and dimensions of all existing and • In�icate NoAh <br /> proposed structures on the lot • �how any proposea greding changes <br /> • ERisting and propoe?d utflities � Show measurements � <br /> DO NOl WRItE BELOW THIS LINE O <br /> ' PERMITCONDITIONS <br /> ; 1.All qqs for Impection ah�ll be mede 2�hre.in a6rence•phone 250-8810. � <br /> 2.All work�h�ll be perfqmed In�ccordence with this permit and cunent City of Everett Dasign and Construction <br /> StandeMs�nd SpeciHcatlon�. <br /> 3.GII loation Underqround Service 48 hre,bnfore you dig.TOLL FREE NUMSER 1•800�4248Sb5. � <br /> � �f,c�v C�r.���ov6P.�-/-ve+/� c��— �' fi�- <br /> �,�.,�,,,,, �.,�-�oy,P.�6�'!�✓ :�tj,ta �"�.�90 iz:�aen 000r�sie� � <br /> J-3o-�0 �2s��.s w <br /> BLDG f426.65 Y� <br /> B SRCH t4.50 O <br /> OttVH'J t35.00 <br /> � «o.� a <br /> CHECF; K76.15 <br /> ACKNOWL�EDGEMENT OF CONOITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> les5 the City of Everett lrom any an0 all d2ims for damages. costs. <br /> �7 ,/ expenses, or ce��ses of action that may arise because ol installetion <br /> � iC__—/y� 7/0/qd and maintenance of the improvement or other right-of•way use hereto <br /> i ����IIr l applied for and further agrees to remove same upon notice trom the <br /> Approve0 tor C strudio � � Date Cit replace puCi^:mop�rtv damaged thereby. <br /> ��%l/ /`— 7/ �\+ � QQ <br /> FINAL INSPECTION Date - '�—/' I� � <br /> Approve0 ea Conatructed Sigrature of P.pplicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI7 MUST 8E STARTED WITHIN <br /> � 3200Ce0arStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA98201 BE DILIGLNTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:258•BB10 CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATI(`�I, <br />