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� /��'� �E�E�e t'� m 97 <br /> �8t@�1�Wq�Y f�'e /r hDiic WOA�P�rmn• �5 <br /> / / �l � <br /> AppHcation For � � c� � 777 eiay.o.o�. •���� <br /> PUBLIC V1�ORKS PERMI� °�°�KW°�.F� _ <br /> To1�l Fes s <br /> Len Apol Fw P��E f <br /> Print or Type Only e.�,��o�. s 2���OU <br /> � . � . G.�,�.�.. .m.�o_ �i.�o U«,.,�.. z�" 9h�za� �-y��� <br /> Owner Meiling AdOress City Zip Phnne <br /> ���— <br /> Applicent Mailine Address City Zip Phone <br /> Deecribe Proposed Work � `�/ —'1 <br /> W <br /> Proiect Addresa pl known) � � <br /> Attach four(4)copiea of plena for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline o�street � <br /> • Outline and dimensiona of all existing and • Indicate North <br /> propoaed Btructuree on the lot � � Show eny proposed grading changes <br /> • Existing and proposed utilitiea • Show measuremen�s M <br /> W <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1. All celle tor+nspaction ahall be made 24 hrs.in advence• phone 259•887 5. � <br /> 2. All woik ehall be pertormad in eccordance with Ihis permit antl curreM City of Everett Design and Construction <br /> Standerda end SpecititeUona <br /> 3. Cel�Location Underground Serv;ca 4B hra.betore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> � SiOc� SEwf,�' adicc :/AvE Tn .h'E P�i,,.`�t� 7'a O <br /> T E ��AiiV /N S//o.e'E A✓E. A P�t.cai�T lf/it[ dE <br /> !E[jvi.�GD T'o I�✓sTatG A Smatc /NANNo[,E fusT � <br /> pFf�' THF /�U6't�C iC'.O.lt/. THEN kUit.i A G+�'a r'/T�/ S/OE � <br /> SEGtIE.t TO Md/.✓� <br /> �' �C/Pj����NT /S T7 .BE' A!/�A.�'E� OF TNE SLOPE O <br /> jTAU�L/Tj/ STU�y ON .�+/1C.f'E AvE O'y NELSiJN /{NO a <br /> �I55<^CiA�'ES D�'a•( i�.' i�d.�. A Cn�'y i5 f1TleCNED . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less ihe City ol Everett from any and all claims for damages, coata, <br /> ezpenses, or causes of action that may arise because of installetion <br /> � � and maintenance of ihe improvement or other right-of•way use hereto <br /> �z���"�� y/C/`�S appiied lor and furlher agrees to remove same upon notice from the <br /> Approved for Construction ate City an �tIDreplace�ublic property damaged thereby. <br /> -����� i-�9-,�-� l � l/ � <br /> FIN PEG ON Date ' <br /> Approved as Constructed i nature of pplicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Streel 1&J DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />