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� _ i _ :� _.. / <br /> Date1�'� v�oi,�wo,�:a�,m �!n —yBcsJ <br /> Application For em9 oen�.� _ y <br /> PUBLIC WORKS PERIUI' !T �,-,��,�w�«,��� -- <br /> iolal fee S <br /> LnssAppl.Fee Pai� S <br /> Print or Type Only o.,�,��eo�« s ZO�' <br /> �����������2���1�`�c� �r�75 ga�_ <br /> Owner MailingAtltlre;s C1ty Zip Phone �19� <br /> k u <br /> Applicant Mailing Address City Zip Phoce <br /> Describe Proposr,d Work c' J�I! l ��_y.,� <br /> Projed Address(it known) ����� 5�A�'�-L����1 y��/C � <br /> Aflach four(4)copies ol plans�or proposed work- Draw to scale and note ihe lollowing as applicable: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outline and dimensions ot all ezisling and ! Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremeNs � <br /> DO NOT WRITE BELOW THIS LI�'E <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•fi810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Evnret�Design and Conslmdiun <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.befote you dig.TOLL FREE NUMBER 1•800•424•5$5S. � <br /> , <br /> �' �G.C�-c: �/2GL'`CCt/s7<.. [iL`1 ,-GC7 ? � ��. �.. � O <br /> s�c i� c,� ��t c 4.,� . <br /> � <br /> � <br /> O <br /> a <br /> l.CKNOWLEDG[�dENT OF CONDITIONS <br /> The und�•�-igned owneVapplicant hereby agrees�o hold and save harm- <br /> — less Ihe � dy oi Everett Irom any and all ciaims fo� damayes, r.osts. <br /> / ezpenses, or causes of action Iha� may arise hecause M installalion <br /> .�75 .��� /�✓ �� �,��O aod mainlenance of thc improvement or other righbof-way usc hereto <br /> �K rrf�^ � applied for and lurther agrees to remove same upon notiCe Irom the <br /> Approved lor siructio�� Date Cily and to replace pubhc nropeity dan��ageA Ihereby. <br /> ./"�'�� �_/ �'��� /'/J <br /> FINAL I�'SPF�710N Date ��(�_ /--Z7�ii <br /> Approved as Consirucletl Signature ol Applicant Da1e <br /> everett PUBUC WORKS DEPAtiTMENT WORK AUTHORIZED BY THIS PERMIT MUST �E STA(iTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREA�TER IS TO <br /> EveretC WA98201 BE DILIGENTLY PURSUED ' J COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY U!'J� ANY STOPPAGE OF WORK ON!HIS <br /> PROJ[CT OV[R UO DAYS Dl'R4�ION. <br />