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Date�J�N Pu�bcWoiksP�rmita �p���—�• _ <br /> ApplicatiOn For Bioo oeo�.•_r�rP�/.-IO� <br /> PUBLIC WOR!(S PERMIT PuUi¢Wo�MSFco <br /> Tolxl Fee $ <br /> Less Appl.fcc Paia S� <br /> eaw,�oa o�o S 2(J� <br /> Print or Type Only <br /> , � � `'� �/ � �7 y <br /> �i,i..� /ij ��nC^ ��r:i:L� Llt:2 L�i7 t]?ir'� �Y '�'. '�`/ �/ <br /> Owner Malling Address Gty Zip Phone <br /> �iC !L /!✓l L%.d�'�. Z'�. �c�•- /lf�''� T . �iTf� ����'Lj �1'Y�T- G�Gn _ <br /> qpplicant Mailing Addr^ss 5� City Zip Phone <br /> DescribeProposedWork )Pi � � NGIL��A��tO� L La�f�2—�"Z�� <br /> W <br /> Project Add�ess(if known) �Z r— /SY A� Sr � <br /> Attach four(4)copies ol plans lor pro�osed work- Draw to scale and note ihe lollowing as applicable: � <br /> • Property Linr.s • Centerline ol slreet � <br /> • Outline and dimensions of all ezisting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading chanyes <br /> • Existing and proFosed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor inspection shall be maCe 24 hrs.in advance�phone 259-8810. � <br /> 2.All work shall be pedermed in accordance with this permit and current Cily ol Everetl Design and Constmction <br /> Standards antl Specilicatinn�. <br /> 3.Call Localion Undergrounh Servic�48 hrs.befuie you di�.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENiOFC : ANS <br /> The undersioned owneUapplicant he�eby ay �^ �hold and save harm� <br /> less Ihe Clly ol Everelt Irom any and all �i .�s for damages, cosls. <br /> enpenses, or causes of action thal may an,e oecause o� installalion <br /> L � and maintenance of th�� improvemen� or other right-obway ��r hereto <br /> ? applied tor and funhcr agrees to remove same upon notice t, �m Ihe. <br /> ApP�o�ed iq+iCon� r lion Date Citp and to�eplace public property damaged �herehy. <br /> ///1 a <br /> I%�//� �' L r- <br /> FINAL IN�P'CTION � .te �� ��"'� / T— �G`�"�� <br /> Approved as Construcled Signat e ol p4c�t Date <br /> WORK AUTIIOHIZED BY THIS PERAtIT MUST BE STARTED WITHIN <br /> everett PUBLICWORK�DEPARTMENT 180 DHYS OF DATE PERMIT IS ISSUEO AND THEREAfTER IS TO <br /> � 3200 Cndai Sireet BE DILIGENiLti' PURSUED TO CON,PLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona.259-0810 PROJECT OVER 90 DAVS DURATION. <br />