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i <br /> S-l?��� �%3- �� � <br /> Date �uol:Works Permil. � <br /> eiao oeo�.• <br /> Applica;ion For <br /> P��LIC WORKS PERMIT �°°ro�aF��`ep s_ ' <br /> Len ApVI.Foe Pad $�— <br /> ❑aC�nce Due $ `"'��n <br /> Print or Type Only <br /> �d�l�rl I�V�l�[� S��IS �l l(t ��►'' ��)(�I ' n �3-L-,n7S <br /> Owner Mailiny Address Cdy Zip Phone <br /> ' I � - _—. <br /> Ap,�!icant Maiiing Address City Lu Phone <br /> Describe Proposed Work C� 7�� — <br /> Project Address(il koown) �((X v � � �I, <br /> � i <br /> Attach lour(4)copies ol plans lor Uroposed work- Draw to swle and note the lollowing as apUlicable: � I <br /> • Property Lines • Centerline ol streel � � <br /> • OWline and dimensions of all ezistin�antl • Indicate Norlh I <br /> proposed slructwas on the lot • Show any proposed grading chan9es i <br /> • Exisling and proposed utilities • Show measuremenis � � <br /> DO NOT 1NRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS ' <br /> 1.All calls for i�spection shall�e made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be;�edormed in accordance with this permit and cu«ent City of Everett Design and Construction � <br /> Standards and 3pecitications. 'I <br /> 3.Cali Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> i <br /> r4n�'��C/ �.6 ��CO�uhE�v (;�t� .,�t.sa�xv �lLcC-'.%c��.� O I <br /> ���J /yJ � ; <br /> � �L�(� j-!TJ/ �I..p�GG�[�!^/ �![llrJ � U=r�C(.�GC�yJl _ � '. <br /> 7/ r%� L �i <br /> .Sr G�oze. �iu.GS � �u'`¢il'rl�7°.G'v �l/_!+-ri �c��J �=Gti�✓-2 Cl'�rnx-P��-J ♦A � <br /> r♦ <br /> O <br /> a <br /> �CKN0INLEDGEMFNTOFCOL . VS <br /> 7he undersi9ned owner/applicant hereby agre� ��' ncld and save harm- <br /> ' — Iess Ihe City ot Everetl irom any and all clai. _ ror Aamages, costs. <br /> �� � .� � expenscs, or cai�ses ol action that may arise hecause of mstallalion <br /> ,� �J7"- J/�y�;�' and maintenance of lhe improvement or other righ4of-way use herelo <br /> applied lor and (urther agrees �o remove same upon notice Irom the <br /> Approved lor Cons clion � D e Cit d to replace pub properry damaged Ihereby. <br /> , � �/���� , <br /> FI��AL INSP CTI T—T/-" Date �`'�' '��—�� <br /> Approved as Constructed at re ol Applic n Dote <br /> WORK AUTHORIZt BY THIS PERMIT MUST BE STARTECI WITHIN <br /> everett PUBLICWORKSDEPAR7MENT ig0 DAYS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br /> � 3200 Cedar Sireet BE DILiGBJTLI' PURSUED TO COMPLETION.TNIS PERMII' MA'f BE <br /> Everett.WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonr.259-8810 PFOJECT OVER 90 DAYS DUFATION. <br />