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_ � <br /> r <br /> '1 <br /> Z <br /> r <br /> PuebcWorwsPo��i— /�/A�V <br /> �3 eiaa 000i.. " � n <br /> Date�� <br /> pp0licaUon Fo� p„p„cwo�kaFec s <br /> PERMIT T°�•�F°° -- <br /> � PUBLIC WORKS �eaaFDo�FeaPeiEs <br /> Baianca Due S�— � <br /> Print or Type Only <br /> Ei/t2 � `�Plvl �SK- o-; <br /> ST�E OLScIJ I�O ccKE� �Jc. Z�P Phone <br /> c��v <br /> Mailing Adtlress �y S� <br /> Owner �p'. <br /> • ��� � �VE�� �I Phone <br /> STFvc lSCN c��v zip <br /> Mailing Address iJf-- <br /> APPlicant �n 1 O,7 � ^ ��e� t�� t�� <br /> � '� /i �7F 1 A� (l . Il 1� <br /> Describe Proposed Work <br /> U�l�v I <br /> W <br /> � � , ,� ���cE� � <br /> preject qddress lif known) licable: /w <br /> • Genledine o�street V� <br /> Atlach tour(41�opies ol Plans lor pmposed work• Draw lo scale and note ihe�ollowing as apP <br /> • property Lines • Indicate North <br /> • Show anY P�oPosed grad�ng changes � <br /> • Outline and dimens�ons ot all existing and � Show measurements <br /> proposed siructures on the lot <br /> • Existing and proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 2d hrs.in advance• Phone 259'88�5. � <br /> 2, qll work shall be perbrmed In accordance with this permit and curreM City ol Everett Design and Construclion <br /> Slandards and Specifications <br /> 3. Call Location Underground Service 40 hrs.he�ore you dig.TOLL FREE NUMBER 1•B00•424•555 • O <br /> N <br /> �'{I r��"6 0,��s �e�� ~ <br /> �e e��s.�'�^ "b�,`" W Re� ,��,�� ��"` � <br /> �p P �,� �,,,P3 a <br /> ACKNOWLEDGEMENT OF CONDIT�ONS <br /> The undersigned owner/apP��canl hereby ag�ees to hold and save harm- <br /> less the City ot Everelt irom any and all claims for damages, cosis, <br /> use he�e�o <br /> ezpenses, or causes o� ac�ion tha� may arise because oi i�slallat o� <br /> and maiNenance of the imp�o�emenl or other righFol�way <br /> Date c�Iv�aad io ep�acelpubl c9PeopertYrdamaged herebyn notice �rom the <br /> ` Appmved br Construction J <br /> Date <br /> Date g�9nature ot APPlicant <br /> FINAL INSPECTION <br /> Approved as Conslructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT I:i ISSUED AND THEREAFTER IS T� <br /> 0 everett BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � 3200 Ced��Street CANCELLED BY THE CITY UPOtJ ANY STOPPAGE OF WORK ON TH�S � <br /> [verett,WA 98201 PROJECT OVER 90 DAYS DUFATION. <br /> Phone�.259�8875 <br /> � J <br />