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�. <br /> r <br /> � n L <br /> �BIB—� ,i�i,. �' 7� �7� <br /> �f'�� T� .T!N G �vov r� � � � ,��,�.,��,�,�,�.,�,�,�,��. _� �.�— <br /> ApPlicatior�o� um� oeci.. _,� �,�____ _ <br /> PUBLiC WOR�S R�RMIT ��,,,���,��«�F�a -- A^ <br /> TOI.tI FCP. •S����� <br /> Oless Anoi Fae Paia �� <br /> tn o tn � J V <br /> Print or Type Onty t r r � U�, oam��a o�0 5 7__�c �__ <br /> `[� o� �ri m .-+ ui — <br /> '�" n* � .�-� �a tU <br /> _r A` M r+ .—� <br /> �_ / , �, ' OJ M 111 <br /> J 9�aoG d.5a Sr�� <br /> Owner Mailin�A21a� : � O � Ci�Y Zi <br /> y F � M � P Phone <br /> .-i <br /> t- w <br /> � �,�, �5,,;��� �z�� �� � ,i� �l a s�- -a <br /> Applir,�n1 tA�ihngAddres5 City Z�p� �� <br /> Phone <br /> Describc Proposed Work _.LV�� „y�i� 1��,� ��G�P �n �P. {�U iI /Nu r <br /> T <br /> Project Address(il known) �=�� �C-' - 7 7=�'Sf- � <br /> Attach lour(4)copies ol plans for proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Properry Lines � <br /> a Centerline ot street � <br /> • OuUine and dimensions of all existing and • Indica�e Nor�h <br /> proposed structures on the lot • Show any proposed c�rading changes <br /> O ExisUng and proposed utilities • Show measurement; <br /> ' DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calis for inspeclion shall 6e made 24 hrs.in advance-phone 259-8810. ' <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction � <br /> Standards and Specifications. <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL/FREE NUMBER 1•800•424•5555. <br /> �. :�ti�' :J:�'-C.t.-F U J��/1� �! � ,�'�` � <br /> �� � s �� � �/ 9 <br /> � <br /> � <br /> � <br /> � � <br /> � i <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Cily of EvereU lrom any and all claims lor damages. cosls, <br /> � expenses, or causes of aclion Ihat may arise because ol installation <br /> and maintenance of the improvement or other right-ol•way use here�o <br /> AP �ved lor Co struyj � Date applied for and further agrees to remove same upon notice f�om the <br /> .-`_� � City and lo rePlace public proPerty damayed thereby. <br /> ' � �O J� <br />� FINAL INSPECTION Date <br /> Approved as ConStructed Signatwe olApphcant <br /> Date <br /> eveiett PUBLIC WORKS DEPARTMENT VVORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUEC AI'JD THEREAF7ER IS TO <br /> I EveretL WA9B201 BE OIL�GENTLY PURfiUED TO COMPLEfION. THIS PERMIT MAY BE <br /> Phone:259-8810 I CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJEC7 OVER 90 DAYS DURATION. <br />� <br />