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�a ��s —� <br /> Date�� � ������wo�w������.,� . _���� c � � � � <br /> Applicaton For e�a�.oepi.+ 0,.:z✓�_. I <br /> � <br /> PIJCLOC WORK� P'EF�N117 � P�����w�,kSFeb _— — ' <br /> T�im F�� �+_ <br /> L=55 AOPI Foc Pain $ �, I <br /> Print or Type Only e��,���o�� s GPi _ I <br /> �t�-L1�tl�[�C 4. `�O('/Y.f Lt/ Cnn�r,/�iL SPr�71�� /r4 /�'i� �3 ri — rt 2 yS ' II <br /> Owner Meiling Address City Zip Phone , I <br /> IS� "` p' -- I � <br />� Applicant PAailing Addres; City Zip phone � <br /> / � �" r ' <br /> Describe ProPoseA Work pqJ �Cy�P M1�C '�,f//1A�r �/!�1'eF/(��-/(� e. _ <br /> J. �,,.�r��. <br /> _ '_ -- i <br /> " Jr c' � <br /> Pioiect Address lif known) _ z � – ���� � ��.� _, C_ L_c�T � Z� � <br /> Atlach four(4) copies ol plans for proposed work- Draw to scale and note the followinn e�applicahle� � i� <br /> • Proparty L�n=S • Cen!erline of slreet � I <br /> O Oinline and dimensions of all eaisting and • Indicale Pi�rih <br /> proposed structures onthelot • Show any p�oposed gratlin� changes <br /> O Existing and proposed u!ilitiea • Shcw measuraments <br /> DO N!�T WR!TE BELON.�THIS LINi. � � <br /> PERPdIT CONDITIL)NS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pe�tormed in accordance with ihis p�rn.it and current Ciry of E��erett Uesign and Construr.tion <br /> Standards and Spec�ficatio��s. <br /> 3.Call Location Une�erground Ser�ice 48 hrs.before you dig.TOLL FREE NVM6ER ',-800-424•5555. � <br /> � <br /> y� <br /> � <br /> �q <br /> M�la <br /> HCf(NOWLEDGEtiiC-NT Of MNDITIONS � <br /> The under,igned a.vnedapUlicant herel�y a�ree=to hold and save harm- <br /> � less the City ol Everett irom any and all claiins for damages, costs. <br /> ��� ,, '^^ / expenses, or causes of action that may arise because of installation <br /> \I IIYI��� I O � and maintenance of ihe improvement or othar ric�ht�oFw2y use hereto <br /> �� � t l applied lor and furiher agrees to remove same upon notice liom the <br /> Approved for Construction� ate Ciry and to replace public property damaged thereby. <br /> �� � �� ^7 <br /> �l�cC._ f � �/- l�� v, �µ _/ <br /> FINAL INSPECTION Date /J'�""`��� _— �'�` ':���� <br /> Approved as Conslruc�ed Signature of ApU�icant Date <br /> everett PUBLIC WORiCS DEPARTMENT WORK AUTHORIZE� f3Y THIS PERA111- MUST BE STARTEU WITHIN <br /> � 3200Cedar;=lreet 180 DAYS nF DATE PERMIT IS ISSUED ANG 7HEREAFTER IS TO � <br /> Everett Wf.38201 8E DILIGENTLY PURSUED TO CGMPLETION. T!11S PEFMIT MAY BE <br /> Phone:25�-8810 CANGELLE� BY THE CITY UPON AIJY STOPPAGE OF INORK ON THIS <br /> PFOJECT OVER 90 DAYS UUR�TION. <br />