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� � <br /> a� H' <br /> �� y <br /> ,% <br /> .. _'_ �_,. ._y, _ .� 9 <br /> �H '{I '/�_ ' (� � ' G G r�ne�wo�x:Perm�S�,C `7�_ . <br /> cn H Date �< oiao oao� . i <br /> �7+ A�plication For <br /> �� PUBLIC WORK� PERMIT PLTotrtFeefce $ <br /> n �ezs Ano�.Fec a.,�n S <br /> � � <br /> �I-�Y n BatanceDue $ �� <br /> y y Print or Type Only <br /> C� <br /> gy H ,� �I�{� ����r`� �C a ��'�' r'�i �c � il�i.��ilf�� c�R.�7S <br /> n�� _K ���y Zi� Phone <br /> Owner Mailing Address <br /> �o � ��yp - ,�Pa <br /> - � � � � Mailing Address City Zip Phone <br /> Applicant <br /> Describe Proposed Work <br /> .5�� <br /> _ � <br /> r�l Ci`.� Z �' �'� ik��= 1-J -- � <br /> Prolect Address lil known) " <br /> � <br /> Atlach lour�4)copies ot plans br proposed work- Draw�o swle and note the following as applica6le: � <br /> • Property Lines • Centerline of street <br /> • Indicate Norih <br /> • Outline and dimensions ot all existing and � Show any p•oposed 9rading chan jes <br /> proposed slructures on the lot � Show measuremen!s M <br /> '�' • Ezisting and proposed uti!ities W <br /> 1 ' DO NOT WR�TE FfELOW THIS LINE O <br /> � <br /> PERMIT CONDITIONS � <br /> '�' i.All calls tor inspeclion shall he mar:��24 hrs.in advance-phene 2�9•881 O. <br /> 2.All work shall be pedormed in accoidance witu this permit and curre�t Cily ot Everett Design and Construction <br /> Standards and Speci'ications. � <br /> '�' 3.Call Loca�ion Undergiound Service 48 hrs.betore you dig.TOLI FREE NUMBEN 1•800•424•5555. <br /> ' O <br /> ' � <br /> ij' � <br /> �_ � <br /> ►—� �' <br /> - <br /> _� <br /> �' <br /> ACKNOWLEDGEMENT OF CON�ITIONS <br /> � <br /> C,� � �� The undersigned ownedaoplicant hereby agrees tu holo and save arm- <br /> less the Ciry of EvereU Iroin any and all claims tor dam�ges. costs, <br /> eapenses, or causes of adion lhat may arise because ol ii,stallat�on <br /> � 1��� � and maintenance of the impwvement or othcr righbobway usc hereto <br /> �� ��L\_�, ( J applied �or a urlher a�rees to iemove same upon notice fwm the <br /> Approced for Conslruction � Date pit n Ie r pl ce ublic operty dama9ed thereby <br /> i����� " ����� 2 2 � <br /> , . <br /> FINAL INSPECTION Date Uate <br /> Signature o ApPlicent <br /> Approved as Construc�ed WORK A:ITHORIZED BY THIS PERM1tIT MUST B STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT tA0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> �� 3200CedarStree� BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MNY B[ <br /> 4 _ Everett,WA98201 CANCELL�D BY THE CITY UPON ANY STOPPAGE OF WOqK ON THIS <br /> v Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />