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i <br /> Date�O—�I P��o�,�wo,���o, �"� 3�0 l� � <br /> Application For ein9.o�•pi., . _ ___ � <br /> PUBLIC WORKS P�RMIT �°°,��°W���=F�.e � <br /> .o�a�F�� s <br /> less Anu1.F?e Pae $ i <br /> CC� <br /> Print or Type Only e��,���o�� s �'— _ I <br /> ��'�12��� fi—� �C 7� �j�)� �� �Z�_ I'� <br /> Owner Madmg Address Cily Zip �hone I <br /> Applicant Mailing Address Ciry Zip phone II <br /> .�,/7 i <br /> � Desr�:be Preposed Work ��r �-- �� <br /> � <br /> I <br /> i <br /> ProjectAddre�s�ifknown� � I —T�T�"� PL-�GL- Sv� IVCW �7L.E1�e�- � � � <br /> y 1 � � <br /> Attach four(4; :opies ol plans for proposed•+vork- Oraw to scale and note the lollowing as applicable La 1 � � <br /> - • Property Lines • Ccnterline of street � <br /> - • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O �I <br /> _ 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � � <br /> 2.All work shall be peMormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 4� GL9j�.i3 , G��TfZ�Z /��� �l DL I�-1t\�.K 5 /�-�ZG 1-�E'W O <br /> �4 ��f� v(� �1LC�,F ►�(� ,�N�t' 17/kMitC�E L.11l..(.� t`�jF IzC:Y'IAGc <br /> �^i� K.C-Pa��n� n�o TF�-e <��Ti �`�At:nc� ��F 'Tt+z� i�t3�•IG � <br /> l�l��K� ��sr�zY� , r,�{ -r�t-e APr-�-+ �� � <br /> � <br /> 5 . ��:o� nrz a� r.�; -��� g� c.r r�%NEc.i�� �r-�, -r�-i�� ��c.c-� a I <br /> c�k'.A, �v S . ! <br /> ACKNOWLEDGEMENT OF CONDITIONS I� � <br /> The undersigned owner/applicant hereby agrees to hold and save harm- '� <br /> — less the City ot Everett Irom any and all claims for damages, costs. I <br /> " I expenses. or causes of action ihat may arien because of installa�ion � <br /> �n � � l�'� � . �� C and maintenanr.e of lhe improvement or other righFol-way use hereto <br /> X' '��---��� appiied for and fur;her agrees to �emove same upon notice from the <br /> ,Opproved for Cor.structio� Date C'fy d to repl�9 e public pro�p�rty damaged thereby. <br /> ,--'��� � .��(�G�C� /Y�;'1�/� �J/IC- <br /> �-/7•ia // <br /> FINAL INSPECTION Date '��� �����+ '����� � � � � �� . <br /> Approved as Consiructed Sign ture ol Applicant —� Date <br /> everett PUBLICWORKS�EPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br /> Phone:259-8810 pFOJECT OVER 90 DAYS DURATION. . <br /> � <br /> . i <br /> i <br /> � <br />