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1'ubnr.Wn�srmmu+ � � <br /> Date�``� — <br /> App�lention For mna oeai . 11 <br /> PUBLIC WURiCS PERMIT '°°:oWF�;`�° 5 <br /> �cea aon��Fca aam S—f` <br /> Bnlnncv Oun $ 4�� <br /> Print or Type Only <br /> �t�� �-� Cycov�� IQ,��y .��? A ,� �� �a� � u�v�,� r�� 9� �-� r <br /> Owner Mailinp Address City �-2ip Phone <br /> G.Q4��1�'- <br /> Applicant Mailing Address Cily 2ip Phone <br /> Describe Pwposed Work � 1'�-f'-�� ��IC . � �T rJ t'�t'f 1� I�,�1( 1 l—L �(' � — <br /> - W <br /> Project Address(il known) �5�� � L���� � T '✓'F � <br /> Atlach iour(4)copies ol plans lor proposed work- Draw to scale and note Ihe lollowin9 as applica'ila e <br /> • Property Lines • Centerline ol street � <br /> • Oulline a�d dim�nsions cl ail existing and • Indicate North <br /> proposed siructures on ihe lot • Show any proposed gradin�changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIJNS <br /> t. All calls for inspec�ion shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall 6e performed in accordance with Ihis permil and current City ol Everett Design and Consiruction <br /> Standards and Specilications. <br /> 3. Call Location Unde�grounG Service 48 hrc. before you�lig.TOLL FREE P�UM@ER 1•800•424•5555. � <br /> S� I/JSTA�C �t/E.cd I>,�'i!/�l�J.S'� l�_F.C' �/r/ crTi9•d�l�i'!� ��OT O <br /> S i�!!'1Od,�" C!v �,('ir%��J.�'f/ i�E/:' �CTnn/ ,1; � 7. D� TNF � <br /> C/T{/ [;< re-;ri:"_FT/' l�FS.c /.� f/� �1��,'�Tii!7�C'i`� ST.✓�I.OF'n��S . <br /> i � <br /> O <br /> � <br /> �tCHNOWLEDGLMENT OF CONDITIONS <br /> ihe undersrc;nrA owner/a 7plicam he eby�grees to hold ano save harm� <br /> — less the City ol Everet� Irom an� � ' all claims for damages, cosis, <br /> �� /'i. / expenses, or causes ol action th� ry arise because ol �nst311ation <br /> �_ �(!n� A L/��_ _ 4 . and maintenance of the improve� � r olher righbof-way use hercto <br /> � yC -�^ %t7C�tg opplied for and luriher agrees t� ��� ��:e same upon notice Irom Ihe <br /> qpproved for Con;VGcti � • �a�� City and to replace pu6lic prope� . � .,naged ihereby. <br /> / <br /> _��ll/�� l-� '-�'� ._. A ` <br /> FINAL INS�ECTION Date ��u��� ��/���t �`IL�= p� <br /> Approvetl as Constructed Signature ol Applicant ate <br /> rvcrclt PUBLIC WORKS UEPARTMENT WORK AUTHORI2ED BV THIS P[RMIT �,�.UST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DAT[ PERb11T IS ISSUED AND THEREAFTER IS TO <br /> [verett,WA 9820� BE DILIGENTLY PURSUBD TO COMPLETION. THIS PERMIT MAY BE <br /> Phona 259�BD1 5 CANCELLflD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJGCT OVER 90 DAVS �URATION. <br />