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� � � <br /> H � <br /> � N . <br /> t" yxay _ . . . . ._ . . . . . <br /> Hxh�+ ,'/_ 'n-` <br /> � H ".0 Date�L�V -��� �""� n�oec wo�xs po�mu. I <br /> / �' �±/� <br /> � �"� � / Application For oieq Daot+_�a �_ . <br /> � o � PUBLIC WORKS F�EFtMnT °°°To,rFeefee � <br /> O H d �esa nnoi.Fce Paw 5 __ <br /> �i tn+f O Print or Type Onry o����=�o�0 5 <br /> �I]Y (] <br /> y !�-�n �-9i �!8'," �l e e. ' � <br /> zH <br /> H H ��� <br /> r r � 5- f�� l i/u �/<PC775- ,P S � oG) �/53-/6�/� <br /> �y U� Owner �dailing Atltlress City Zip Phone <br /> O H <br /> C] Gti <br /> �� 1��>-�i� �c�t1-I- .�a6 -�3 � Ct.�r ��,h��.,ti 9So�a Fs:,3-Gs-93 �, <br /> --� <br /> y y Applicant Mailing Atldress City Zip Pho�e <br /> HOtn I <br /> __ , <br /> Describe Proposed Work 7P�,1(T n y' r��'�/�(,�et� ' ��+1" /'v _�c C I Q(k,��,���/' �I <br /> J <br /> � I <br /> ProjectAddress(ilknown� ���c2� LI:P/�CNf�_��(Y..n � <br /> Attach four(4�copies of plans lor proposed work- Draw to scale and note the foilowing as applicable: � <br /> • Property Lines • Centerline ol strecl /w <br /> • Outline and dimensions ol all existing antl • Indicate North V, <br /> proposed structures on the lot • Show any pwposed gratlin9 changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WHITE BELOW THIS LINE O <br /> '�I PERMITCONDITIONS I <br /> ' ' 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> � 2.All work sha11 be pedormed in accordance with ihis permit and current Ciry of Everett Design antl Construction <br /> '�' Stantlards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FHEE NUMBER 1•800•424•5555. � <br /> ' ' � <br /> �' �t3 L� L 1�{o fz Kl� -�C1G.M I'l` �c1T �cZ��i iz�� � <br /> � ♦A <br /> j-' ��V� `�-- v� <br /> _ � J����� 0 <br /> I � aj <br /> ► I <br /> _ � <br /> I_I � <br /> ACKNOWLEDGEMENTOFCONUiTIONS i <br /> The undersigned owner/applicant hereby ac�ree,lo hold and save ha�m� <br /> 1�1 less Ihe City of Everelt irom any and all c'�ims for damac�es. costs. <br /> ,____. expenses, or causes o1 action that may anse because ol installation <br /> and main�enance Of �he improvemen� or olhel figh��oi•way Use hereio <br /> applied lor and further aqrees to remove seme upon notice Irom Ihe <br /> Approved for Construc�ion Date Ciry and lo replace pubtic properry c ama9ed thereby. <br /> FINAL INSPEGTION Date <br /> Approvetl as Consiructed Si9nature of Applicant Date <br /> evemt[ PUBLICWORKSDEPARTMENT W�RK AUTHORIZED BY THIS P[RMIT MUST BE STARTED WITHIN , <br /> � 3200CedarStreet 180 D�YS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br /> Everett WA 9B't01 BE DILIGENTLY PURSUED TG COMPLETION.THIS PERMIT MAY 8[ <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />