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I <br /> u <br /> V <br /> �11P��5�1 <_ - - ��-�- �`�� 4�' � <br /> Date PUULCWorksAxrmi�� _ � <br /> � Bhl] Oepl.s ._C�_' ��G�\ <br /> .�ppiicadon For � <br /> PUBL�C WQ�FiKS PEF�MIT P°°�°W°,�s��r----- -- <br /> Tutal Fer. �___"—_— . � <br /> O <br /> O� Lrss 1fi'I `rp P.n,i 5 —__"___. .. <br /> � ..�� _" <br /> � 0 � O ,'_.I...,� ,.r�,., 5 __r__�- <br /> Print or Type Only � o o in _____________ <br /> � � aNN � <br /> u� � u. ut <br /> (o`���I � 1 LD'� f�VP �.��-.�� ��`-„' �E� �- l�-�`�1��;� <br /> Ow r — � � Mailing Addre55 � N C.J N(Fiy([.�� �- � 7;:� Phone <br /> N O [U O � 47 > = <br /> � 'A � 3kG] S W W � U <br /> �� <br /> Applicant Mailing Address City Lp Phone <br /> Describe Prnposed Work L �' '( l -�� � e �-/�� 1 /"'��� _ <br /> � 1 - �� <br /> Proiect Pddress(il krown) � � � ���}� `=-I. � Sw _ � <br /> 2 <br /> Attach four(4) copies of plans for proposed work� Dra�ro to scale and note the following as applicablE: � <br /> r Properry Lines • Centerline ot street � <br /> • OutGne and dimensions of all existing and • Indicate North <br /> ��roposed sirucWr� on the lot a Show any pruposed c�radinr changes <br /> � �zistinq and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS L�NE ��e� � <br /> PERMIT COWC�TIONS \� <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8�10. � <br /> 2 All w�ork shall be peiformed in accordance with this permit end current City of Everett Design and Construction <br /> Standards and Specific2tiocs. <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TO!L FREE NUMBER 1-800-424-5555. :� <br /> �d <br /> � <br /> � <br /> � <br /> � <br /> P�i <br /> 1: <br /> ACVWOWLEDGEIdENT OF CONDITIOIJS �� <br /> lne undersi9ned ewnedappLcant herehy agrees ro hold anJ s���e honn- <br /> — — less the Cily ol Everett Irom any and all cleims for damay��s. cnsL•;. � <br /> expenses, or causes of action Ihat may arise because nl inslallahor, �,: <br /> ,.L � �1 L��� (h, --7 t� and maintenance of Ihe improvement or other right-ohway use he���h�� <br /> '� L� � ! -�� � <br /> app0ed tor and lurther agrees to remove sam�� upon notice from !h,.� <br /> Approved for Constru n Date Ciry a�,d to replace public prop�l�ry damai,}ed ihereby. <br /> A,� / �� � � <br /> %'C� � ��`�� � ��'d . <br /> FINAL INSPECTION DateC-'�� z.��l'y2��L � '/���� ) �- ���C� <br /> Approved as Constructed Sig`nafure of AppliCaM�� v ate � <br /> everetl PUBLIC WORKS DEPARTMGNT �WORK AUTHORIZED BY TF{�$ PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireed 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> f3E DIU� fNTLY Pi1PSU[D TO C(1�1PLETION. THIS PERG1IT MO,Y BE <br /> Everefl.WA99201 I �..��ri � r '. Pi r IT . �. � '. )� t :.ar r�i�"i '�;�� :���C <br /> Phonc:959 f3E310 <br /> f <br /> �� <br />■ <br />