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I <br /> I <br /> 7 ,��'_ � PULLc 1YOrk5 Pn�mil� �L./ ��� / � <br /> Date <br /> � r <br /> 6�nq Oeo� •_ .-- <br /> Appiication For u'. <br />, PUBLIC WORKS PERMI� �'°°,��°,°°„°`�e S ---- <br /> io�al FeP <br /> LP55<plll Fnn PA�:1 S O <br /> Print or Type Only <br /> g g e..ir„��.o��� 5 20�� <br /> � F2 002-322Yo/ y83 / <br /> /�{ENoRic�s <br /> `�� MA�'L E/1�� �1vr0 '� �.t�7`/ylOr�� �ve.��P V6� 9B 20 / <br /> OWn¢� A^a�•iny Ar,i1reS--\. ��ZiP Phonr, <br /> 7 _ g�i y� <br /> �Sf��IC_ 2�_ ,s U = — <br /> AppliCan� M,,�hn:;Adclress GI�; Zio Phona <br /> Describe Pro�osed Work ���F__.�--�LS-L�/�--�¢- —J�,:1..L��J��.��t��� ---- <br /> �� x 2a--- -------- - - - <br /> ._—.. F,[n. li¢re� . _-------- W <br /> Prolect Atldress UI known! �SL���e���-�-------- —==—'�e`—�J�r--y•�� 2� � ' <br /> Attach low(4)coP�es ol Plans fo� D�oP�����'��'" � Diav: to �ra'�..c'..t ��Ue m��'oquwmq as anplrr.ahie. � <br /> • Prope�ty LIneS • Gen�erlme nl StreF1 � I <br /> • Out6ne and dimensions ol all enshng anA • 1ncLcale North � <br /> proDosed slruclures on ihe lot • 5how anY r.r000sed gradmn r.nan:�es I <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE 6ElOW THIS LWE O ��, <br /> . PERMIT CONDITIONS <br /> �� 1.Atl calls tor insp�:.tion shall be made 24 hrs.in advance•phone 259•8810. � <br /> � 2.All work shell be pedormed in accordance with this permit and current Ciry of Everett Design and Construction <br /> � StandardsandSr.ecifications. <br /> 3.Call Locatio�Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800�424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS � <br /> J!�,�i�n�rrs�pneA o�aneNapphcani hereby agrees to hold and 52ve harm� <br /> — ---��-- �"-----�� less ;h•a Gity o� [vr,retl Iwm any and atl daims fo� damayes. costs. <br /> ; e*pensrs. o� ::auses of ac��on that may arise because o� in5lallation <br /> _., /��� �, and mau�tenai�ce nf thr improvement or o�her nghl-ol�way use herelo <br /> �� � ,i;pim,� foi and �urther agrees to remove samr. upon notice Irom ihe <br /> Approved 1 C ction % ���0 - C^� �r�d tn renlaca uuUho pronerry Uamaged thereby. <br /> ( <br /> J,1 .1 ) �' 7� ���'��,, � ��. 7"��y� <br /> FINAL INSPECTION Date �Li�LE�FY"�/P Gf1 5r— <br /> Approved as Constructed <br /> Signatme ol Applican! Date <br /> 1VOP.K AUTHORIZED 9Y THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT I 780 �AYS OF DATE FERMIT IS ISSUED ANU THEREAPTFR IS TO <br /> 3200CedarStreel �� 3E DILIGEIJTLI' PURSUHD TO COMPLETION. THIS PERMIT tdAY BE <br /> Everett.WA 9820t C4NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 �� pRO.IEGT OVER 90 DAYS GURATION. <br />