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I.-- -- -- ---- - �— --- ------ —__- - ---- — — -- <br /> � �,�_ �..��,_;�i.., - --- ---� : <br /> � ��$� ' � 8 �- <br /> Cate '��, �����,��vo,.�Pe�p • �c�f�s—s�--/- <br /> �4� � AppliCa�ion Pnr Oiep Depl • <br /> , PU� IC WORKS PERMIT P���cWo�bree f - <br /> i o;al Fne <br /> � Leu Rppl Fco Par� S <br /> O <br /> � �abnr,e Due S_ O�� <br /> ' Print or Type C�nly <br /> i <br /> i <br /> ����. r� �� .�r�x ���8 I )'1 � � ,�" ��1 GB��S <br /> Owner � M:�ihng Address City Zip Phone <br /> l< < � _ 8d"7- ��19 „ <br /> Appiicnnt ,Mailin3 Adtlress City 2ip Fhone <br /> Describe ProposM Woik _ ����_ � Jl � _ ___ <br /> ProjectAddresslilk�own) ��Z$ �-t������ F�"c=. � <br /> � <br /> Attach low(4�copies ol plans lor proposed work• Draw to scale and note ihe following as applicable: � <br /> • Property lines • Centerline ol streel � <br /> • Outline and dimensions oi all eaisting antl • �ndicate Norih <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Exieting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS • O <br /> t.All rslls for inspection shell be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in acoxdance with this permit and current City ol Everelt Design and Construction <br /> Standards and Specilications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> J• /-4-ts-e- ��.�.c.vu�Q.�r 6� .�0 7rto.e� S�/tcr� j��L�wn� . O <br /> -_ , e <br /> , H <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMFNT OF CONDITIUNS <br /> The uadersic�netl owneU� pplicai � � �eby agrees to hold and save harm• i <br /> --�— less the Ci�y ol EverMt irom a•, �-nd all claims for damages, cosis. <br /> e�penses, or causes ol aclion ��at �ay arise because or instailation <br /> �?����1U ��L ��C .8 B9 antl maintenance ol the imr.ro:e�uant or other righPol-way use here�o <br /> applied br and further agrees lo iemove same upon notice irom ihe <br /> Approved for Con,tru�d'/io�n � Date City and to repince puUlic proF� �y damaged thereU��. <br /> �.---��JG�/ S''��`�S'� . <br /> i� <br /> FINAL INSPECTION Date _��s�._ �� �-"r�'9p <br /> Approved as Constructed Signalun: of Ao licant Date <br /> everett PUBLIC WORKS DEPARTM[NT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200C:edar5ireel 180 OAYS OF DAiE PERM . IS ISSUED AND THEfiEAFTER �5 TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAV BE <br /> Phone:259�8810 CANCELLED 8V THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJE:CT OV[R 30 DAVS DURATION. <br />