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qate_I� � PUELc Workf Pttmil s �! ', <br /> Applitation For Biap.oeo��•��U�, s�� <br /> f�UE�LIC WORKS �ERNiIT P°°���,�°-�°F°a — <br /> To1N Fen s <br /> Lesa Ao��Feo Paid S <br /> Print or Type Only ea�a�«o�a a <br /> ) !� <br /> �1�U��[i (e ��''��:c l g�J1`I � ��f ���i t��� ���Cari'z '�5� (��(a�/ <br /> Owner Maiting Addr� � Cil Zip Fhone � � <br /> ��ig�lnr� ' 'u f (r��z I �f�Gv� ��l L-��r�� , i ��c�� 3 C.� ��?-/�-�-- �� <br /> ApD��-ant Mai irig Address City� Zip —� Phone <br /> �� ,a.LG-�—� / � / /�' � /�' /I � <br /> Describr. Proposed Work � Z-{�`, ��11 � �.yl C7�_ (�. <br /> —_ � <br /> � � � <br /> Projecl Address(it known) � - � <br /> Attach iour�4)copies of plans lor proposed work- Draw to scale and not e lollowing as applicable: � <br /> • Property Lines • Cen�edine ol sireet ♦A <br /> • Outline and dimensiors ol all axisling and • Indic�te Nor�h V� <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Existing and pioposc.d utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERI�i1T CONDITIONS O <br /> 1. All calls for insper,tion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2 All work shall be Performed in eccordance with ihis permit and current City ol Everett Des�yn and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /��� !`C��h'7i% ti7l ' iC�'-'Gj'��//.�/C7 � d <br /> C_�j��!{/ � <br /> i/i <br /> �s- ��6 � <br /> � <br /> . <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 7he undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry ol Everett Irom any and all claims lor tlnmages. costs, <br /> expenses. or causes ol action Ihat may anse because ol installalion <br /> and maintenance ol the improvement or other ric�hPobway use hereto <br /> applied for and luriher agrees �0 remnve SamC upon nO�iCe frOm Ihe <br /> Approved br Construction Date City and lo renlace public nroperry damaged there6y. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Si�nature ol Applicant Date <br /> everc�t PUBLIC WORKS DEPARTMENT WORK AUTHOR12ED Bl' THIS PERMIT MUST BE STARTED WI7HIN <br /> � 3200 Cedar Streel 1B0 DAYS OF DATE PERId1T IS ISSUED AND THEREAFTER IS TO <br /> Everetl.WA 98201 BE DILIGENTLY PURSUED TO COMPlE710N. THIS PERMIT MAY BE <br /> Phone: 259-BB15 CANCELLED 81'THE CITY JPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEP 90 DAYS DUR�TION. <br />