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Date�/ �V>� f�uLI.0��iO�kS(Clm�l v <br /> � � <br /> ��.1g Denl.a� � <br /> Applica�ion For <br /> �C� PUBLI� WORKS PE{�IVIIT" '°°"""°"_`�°— � <br /> fo�ai Fce S <br /> LessAnO� i�:ePnic' S �ry^-� I � <br /> ��� 'if�i:�n�e Guv S�J�— <br /> r ~ Print or Type Only <br /> 9 H tn <br /> H �� <br /> � zH C% <br /> '< y z �r�FIR'�U� � 1[�l,V')"1 � l�Zl'r; I i��I i I � I F'1�I�1 I �� I���ii � ��I�%�� I`�DI'�, '7�/� � `��77G�. _ <br /> ,�-�' H� Owner ldai ing Atldress Cdy 7.ip Phone <br /> VJ H <br /> � o� .�`' ' '1 �I� fi�'{ k''L'7f ''� `�-� /-'ll�K?►'-'�n ��LL f�l� �IlY�� �5�-h`z:�'_� <br /> y d pplicant Maihny Atldress Ciry Zip Phone <br /> 117'1L ) I5 )/"2! f- ����-�J-c� <br /> H <br /> ��� Describe Proposed Work � <br /> H <br /> z9y� <br /> rHy 1 , 1 <br /> �' W <br /> H <br /> C] C7 C/� — � ��-� � L � � <br />. � �� Project Address(if knownl .��–�=�<�r— � <br /> H O U A��ach four(4)copies ol plans for pioposed v:oh� Dra:: fo scale ;�rd �is:c!h,: �ollowinq ��apPlicable: � <br /> • Property Lines • G�nlerline 's�reet � <br /> • Outline and dimensions of all existin9 and • Ind�cate N, n <br />� proposed siruCtu�e�,on Ihe lo� � Show any Proposed 9r:.tling ahanges <br /> • Existing and proposrd utili�ios' • Shov+measuremenis M <br /> W <br /> � DO NOT WRITE BEIOIN THIS LIP;[ o <br /> PERMIT CONDRION; <br /> �' ` 1. All calls lar inspect�an shail Im maUe 2a nrs. in advance� phone 259$8�5 � <br />� - �� 2. All work shall h^perio�mud in accoidam>o�rAlh ihis permd antl current City o! Everett Design and Consiruclion <br />' Standards anC Sper.ihc�tions <br />� 3. C�tl Loc�hon Undcpioin���Sc��i��.iB hi�. bebr�• yau tlu7 TOLL FREE NUMBER 1•8�0-424•55rJ5. i� <br /> 0� � G <br /> � � � <br />� ��� <br /> Y/ <br /> �«�� O <br /> e ��; a <br /> �: <br /> '1 �� . <br /> ' ACKNOVdLEDGEAtENT OF CONDITIONS <br /> r�. <br /> The undersi9ned ov+neri iPPlicaN hereby agrees lo hold and save harnr <br /> II --- -- -- less ihe Cily ol [verelt Ir�m any and all claims lor d�mages, costs, <br /> I /,,�–__�_ . expenses. or c�uses ot action Ihat inay arise �ecause of installation <br /> �% � and maintenance ol ih�� improvemen� or other riyh��ol-way use nerelo <br /> Y � � � <br /> i applied (or and lurther �J«es to remove same upon notice from the <br /> qpproveA for Construrt� Date Ciry and lo replace pu lic property c maged thereby. <br />�� � � �- ���� ��� � <br /> �� 1 -��l d--�' i� ��r �� � CGa ��=11.1C. I?, I�'�`'�7— <br /> Date � � <br /> FINAL INSPECTION Siynature of Applicant Date <br /> Approved as Constructed <br /> WORK AUTFIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> i.�i���� PUBLIC WORKS DEPARTM[NT ��0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLFTION. THIS PERMIT MAY BE <br /> [vereit,WA 98201 CANC[LLED 8Y THE CITY UPON ANY STOPPAG[OF 670RK ON THIS <br /> Phane'. 259-A�15 PROJ[CT OV[R 90 DAYS DURATION. <br /> ti <br />