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PutiL;Y:a�k:Purmil v <br /> Date���-�'=�c�� eia� 000i..—_-�_ <br /> � qpplicalion For <br /> VI/ORKS �'EC�IVIIT P�Li�cWo�vsFco <br /> P4IBLIC '°'d'FeC �- <br /> Less ApPL Fae Pa�d S <br /> Balance�ue S—�� <br /> Print or Type Only <br /> � /n�p � ' ioG�3 � 3�'"P�2 � I_��,a �,�r�33 �1�-- <br /> P r��fn� iJN�IME1 �`S=�_� City ZiP ^ Plicne <br /> Owner Mailing Addrzss <br /> � �� p E 9�'za8' � �F-L�'�� - <br /> �jLei% �i1i� 4N/�/Ce� �IMi� ? /P/A �a•J.5'( ����J--- ZiP Pho�e <br /> Applicant <br /> �A4ailing Addre::s y <br /> Describe Praposed Work <br /> ��l��Y1jr_ l��L �� <br /> � <br /> Pro�ect Address(it known) �5 r ��J�t��'� ,�� -�-`—� � <br /> � <br /> Attach fow(4)coF��es o� Plans for proposed work- Draw to scale and nole�Ce^�e�line oi SUeeii able: � <br /> o Prooer�Y Lines w Indicate North <br /> • Outliie and dimensions of all ezisting and � Show any proposed grading chnnyes <br /> proposed siructures on the lot � Show measurements � <br /> • Existin� and proposed utilities <br /> � DO NOT N�RIT� BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calls tor icspection shall be made 24 hrs.in adv�nce•phone 259•8810. <br /> 2.All work shall be performed in accordance with ihis permit and current Cily of Everetl Desiyn and Constructi�n <br /> Sl�ndards and Specificalions. � <br /> 3.Call Location Underground Servica 48 hrs.before yo� dig.TOLL FREE NUMBER 1•800-424-555 • <br /> ' � ��� L ��iC.^..�z7�../s��CrL'-Z".�LF'"`"" O <br /> j�'�����-��.-.�� -� . <br /> H <br /> ��jJ-�^r�P/t/ �/'�L-�' T./��P��"f/t�N,/�C�.iGLF.N" �� �� � Y/ <br /> � � /��'Z�z��£� C/: / �C��'��, .���0 x�/�� � <br /> . � ,, a <br /> `>�� '�g <br /> � / <br /> ACKNOWLEDUEPdENT JF CONDITIONS <br /> The undersigned owneriapplicaN herebY agrces to ho�d and save harm- <br /> -- less the City of Everett irom any and all claims tor dams3es, r,osts, <br /> expenses, or causes oi acDon ihat may arise because ot �.nstall2tion <br /> and maintenance of ihe improvemenl or o�her nght-of-way u;e hereto <br /> applied for and turther ag�ees to remove same upon notic? irom the <br /> '� � Date City and to replace public properry damaned thereby. <br /> Approved for Construction <br /> Date Cate <br /> FINAL 1NSPECTION Signature ot Applicant <br /> ,4pproved as Constructed WORK AUTfiORIZED F'� �H;S PERh11T MUST BE STA'�iTED W�THIN <br /> everelt PUBLICWOFKSDEPAR'fiNEN7 180 DAYS OF DATE PEHMIT IS I�SUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIiiENTLY PURSUED T� COMPLETION. TFIIS PERMIT MAY BE <br /> Everett,WA982Dt CANCELLED BY THE CTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 �90JECT OVER 90 DAYS DURATIO�. <br />