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f <br /> �ate'��1; �1 F����,�,vo,.,P�,m,� t3 —3 /O � <br /> Applicalion For 6�ne Depi.. '� _ � �' � /�Z�' <br /> PUBLIC WORKS PERMIT P���T�;;<<�e���e S_ <br /> �ess nnai Fcr Vnia � <br /> Prinl or Type Only e,�,�«n�� s 2�=n� <br /> � I /J <br /> � -'j l ll(`' rX�`'i��. �,J� � � �1 1 4'�ITi�� ,' •��I_ �•I ��ll `�/.�r�n•=J <br /> �� Owner ,/ Mailing AAd es _.�1:i�y 'Lip Phone <br /> �Lf �_� y��� <br /> Applicant Idailing Addre55 Cily ZiF' Phone <br /> _� �/f r ��1 /1 �,(_ <br /> Descnbe Proposed Work �^��— �' � T, ���� /''( A—It �� ��V�\��/--'����A . <br /> Project Address(il knownl ���� — ����/���� /(%�.�� ,�� � ',, <br /> � <br /> Attach lour(4) copies ol plans lor proposed work� Dr:iw to scale and note the following as applicable: � <br /> • Property Lines • Cenierline nl street /� <br /> • Outline acd dimensions ol all eaisting and • Indicale Norlh V, <br /> pruposed structu.es on ihe lot • Show any proposed grading changes <br /> • Exis'�ng and propose.:utildies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS o <br /> 1.A�I calls lor insper.tion shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in acwrdance with ihis permil and currenl City ot Everett Design and Conslruc�ion �� <br /> Standards and Specilications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> J� /J�i /� � //�'��".-�rr1�� <br /> �� ��LYCQ.�C�7L� �C- �iC4 :'/ i.�C� . �l�J1l^li_�C. [,O�L.C'�C��L��/ / � . <br /> Gviu�..r.- G/uti�t.c��z.-c� � <br /> // � <br /> � � ' • -, <br /> �. C Z��-:� r� !�-,t« �:� ::yl _�, c��/ .� _�/�.; fa.;/�P�,� .�,�E',f-s -r�i <br /> � �' � • // <br /> �g.���� �� CLi.� C�TLL"r/'ii .((�• ��CCclj�% <�i).it{C. .1''.-Lt�.C�ci.�(C'>�' � � <br /> � <br /> a <br /> �J� ACKNOWLEDGEM[NT Of CONDITIONS <br /> r <br /> � V ' Theundersignedowner/apPlicantherebyagreestoholdandsaveharm- <br /> less the Gty ol Everett Irom any and all claims lor damages, cosis, <br /> �,�� expenses. or causes ol action that may arise because of installation <br /> {Z���„�,� ,y��/ and maintnnance of Ihe imprnvement or other righhol-way use hereto <br /> �� 7� apP�ied lor and lurther agrees to remove same upon nolice from the <br /> ApproveA for Constru ion / �� City and to replace public V�oPerty damnged Ihereby. <br /> / //�s �,�— <br /> _ �°�GG�� �—( / ^�U �^!� / � � 7 <br /> FINAL INCF�ECTION Date —'�r_`1�`-a-�� � ��"V-� � - ���� , <br /> Approved as Constructed Signature ol Appli an�v t — Dale <br /> everrt� PUBUCWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> � 3200CedarStreet IBO DAYS OF DATE PERIdIT IS ISSUED AND THEFEAFTER IS 70 <br /> Everett WA98201 BE DILIGENTLY PURSUED TO COMPLETION. 7HIS P[RMIT MAY SE I <br /> Phone�.259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAVS DURATION � <br />