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Date r? oZ3 � ' P�m�<<•,�,ks P�,�n��_ <br /> Application For am9.oeai., �`Z i >�F3 a _ <br /> r <br /> RUE3LIC �lVORKS ��n►�ilT P°b��°W°�k°F°e _ <br /> Totai Poe S <br /> Less Ap�L Fee PaiC .S _-. <br /> B3lante Uuo $ — <br /> Print or Type Only •— <br /> _L�.�M_r���:�.���,�5 .�.-� �;,�. ,r/ S F ,La ��i ls sa 7-a�' <br /> Gwner Mailing Address City Zip Phone <br /> C f� nA P <br /> Applicant Alailiny Address City Zip Phone <br /> DescribeProposedWork �!-C'��!��'i,���r,�a�� �Y' � Pi.�a O�`"1����e$ _ <br /> .���ere�.Nln/l /_'�'�'•P �� <br /> � <br /> —�— - � <br /> ProjectAddress(ifknown) inraa S� ��/ d � <br /> Attach four(�i)copiss ol plans lo�propoc=.0 vmrlc- Draw to scale ari not� the following as app icable: ���� <br /> � Property Lines �� Centerline of slreet � <br /> • Outline and dimensions of all ezist nc�and '� Indicate Nor�h <br /> proposed struclures on the lot O Show any proposed qr..ding changes <br /> � Existing and proposed utilities • Show n�easuremrnis � <br /> o�����+r.•r���v�����i�� <br /> DO NOT WRITE B'_LOW THIS LINE <br /> PERMITCONDITIONS O <br /> 1. All CaP<fr.r inspection snall 6a made 2�t hrs. in advance• phone 259•881 6. � <br /> 2. Afl v.� �:-shall be perlormed in accordance with this permit anU current City of Everelt Design and Construction <br /> Stzr..�crds and Specilications. <br /> 3. Call Location Underground Service�48 hrs. bebre you Aip.'fOLL FREE NUNIBER 1•800•424-$555. � <br /> O <br /> � � �/ (��.J�/G L�ic?r-.[: '' j"r,--.,,,.i /ie�/ ��e�—l�'!.ii.:zJ ���y/�i� <br /> � �l:✓/`� � <br /> , O <br /> a <br /> ACKNOINLF_DGEME,lT OP CCtJDITIONS <br /> The undeisigneA ownedapplicant hereUy ayrees to nold and save harm- <br /> — - — — � less ihe ��ity uf Everett from any and all claims for damac�e&, costs, <br /> expenses, or causes of action tha� may arise because of installation <br /> — I antl maintenance of the improvement cr other right-of-way use hereto <br /> applied (or and further agrees to remose sarr�e upon notice Iro�n the <br /> ApU:oved lor Gonstnicr.icr� Date City apd to replace publiC proFerty damaaed thareby. <br /> L%� <br /> PINAL INSPE:TIOI! D.�.te ��� � � 3���87 <br /> Approved a:�Clonsirucled Signa�ure �I pplicant Date <br /> rrvcet �"�BLIC WORKS DEPARTMENT `N�RK AU�ORiZED BY THIS PER�AI MUST BE STARTED VSTHIN <br /> 3200CedarStreet 1b0 DAYS OF DATE PERMIT IS ISSUED AfvD THEREA'-TER ..� TO <br /> Everett WA 98207 BE DILIGENTLY PlJRSUED TO COMFLET!ON.TH:3 PE��MIT MA," BE <br /> � � Phone:259�8815 CANCELLED 9Y THc CI7Y UPON ANY STOPPAGE OF WORK ON-:HIS <br /> PFOJECT OVEn 90 DAYS DURATIpN. <br />