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„ _ l �-, . _ <br /> �•d�P '. p�iniic Works��o�mn• <br /> _ f-� �J(—�— <br /> AppliCatiun For umn ��w • —'��� <br /> PUBLIC WORKS �ERMIT r��toWF�c�ec S <br /> ��:s nnni F�•e va�a � — <br /> w.��,,��,,o„�. S <br /> Print or Type Only <br /> ( I ''UI��� ��`�`�Z” t�'i� , ���� E�i -� � ,i� � 1� lr -1l�� lr � �•� •"��� � �����'1�1..L_ <br /> Owner Mailing Address Cily ZiU Phone <br /> A�?�JZ�- <br /> ApplicaM Mailing Address City 2ip Phone <br /> DescribeProposedWork I '(����f1n � l ��7�1�'��l���f`/� ��'� ! <br /> /� 7 W <br /> Proiect Address(il knowN JC '"<<� �� t����,\ ��.�� � <br /> A�tach lour(4)copies of plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Property Lines • Cenlerline oi street � <br /> � Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed gradiny changes <br /> � Existing and proDosed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i. All calls loi inspection shall be made 24 hrs. in advance- phone 259•8815. � <br /> 2. Ail worh shall be perlormed in accordance wilh Ihis permit and current Cily of Everetl Design end Consiruction <br /> Standerds and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 'Lir�cic C.�.+��"t �E,er�.T NoT ,-P�q��,eF.0 .�/S/'.'2-8 � O <br /> Yi.C2�f. <br /> '/ � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEM[N7 OF CJNDITIONS <br /> The undersi9ned owner/ap^' ��nt hereby agrees to hold anA save harm• <br /> less ihe Ciry of Everett f� : . �ny and all claims lor damage�, costs, <br /> enpenses, or causes ol � ��c� 'hat may arise because ol instellution <br /> and mamtenance ol Ihe � �• �� •�ment or other right�o4way use hereto <br /> applied tor and lurther a .�:. , to remnve same upon �otice from the <br /> Approved br Conslruction Date City and lo replace publi� ^oerty dana�ed thereby. <br /> ✓ //� �. <br /> FINAL INSPECTION ��� �r� - <br /> Date <br /> Approved as Conslructed �Sign �ure of Applic nt Dale <br /> everett PUBLIC WORKS DEPARTMENT WC�RK AUTHORI2 D BY THIS PERMIT MUFT BE STARTED WITHIN <br /> 18U DAYS OP DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIG[NT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evere�t,WA 98201 CANCEILED B1' TNE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�88�5 pROJECT OVER 90 DAVS DURATION. <br />