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Date�3._� — FJq-- Publlc Works Parmll a " � ��__—_ <br /> B�tl9.Depl.0 _ <br /> Application For <br /> rv���IC Nf�RK� P�RnIIIT PuellcWorhsFea �"�,v . �C <br /> Tatal Feo S <br /> Le;s Aop�Foe Pnld g I� <br /> Balanco Ouo S `}� � �� <br /> Print or Type Only — ��/v�� <br /> i �, <br /> �i� ►���� �� r Ac r_�ic. ,�f �x`J, ec;R l� i:c'� � i4��' i� V'. 5.� 3.Et_����u i� i8nc�'�- <br /> Owner tdaJing Address City Zip Fhone��s i.�� � s-��� <br /> —_7 /� ME' - - - <br /> Applicant Mailing Address City Zip Phone <br />� Describe ProGosed Work � �� �� � '� � n L N � L �C-L � r-� -- <br /> — !�Y <br /> F'w;�ct.4ddress(ifknOvrn) /� ✓ �"� /v — ��• ��' � <br /> Attar.h(our 14) copies o: nlans lor proposed work- Draw to scale and note iha toi�::::ing as applicable: � <br /> i Property Lines • Cenierline of street � <br /> Q Outline and dimnnsions cf all exisling and O Ir dicate North <br /> r.r^posed structures on iha lot • Show zny proposed 9ratl�ng changes <br /> • £wsting and proposed utilities • Sh�e✓rreasurements � <br /> �'�� l'.��NQf WRITE� BE�OW�T�H�` LINE � <br /> PERMIT CONDITIONS �Z <br /> ;. All r,alls(or inspection shall be mao^i4 hrs. in advance- phone 259•8E1 5. � <br /> ^_ .411 work shall be performed in ��cordance with this permil .:nd cu«eat City of Everett Desic,n and ConsVuctior. <br /> Standards and Specitications. � <br /> ?. Call Location Underground Servin�-'3 hrs. beiore yor dig l'nLl FREc. iVUMBER 1-800•424•5555. � �' <br /> F- <br /> r: <br /> r: <br /> � ,. <br /> � � � <br /> �Q� ti � <br /> V♦ ui _ <br /> I � c _ <br /> � J _ <br /> I '? ' <br /> FlCKf:OWIEDGE1.lENT OF COKDI"'IONS <br />�� The unde�signed owner/applicant hereby agrees lo hcid and a3ve tarm- � �� <br /> less the City of Everett irom any and all claims tor damages, costs, <br /> �y"/�9 � expenses, or causes of action that may arise bewuse ot ins'allation <br /> � ,//��G_ �_ �y/_�� and maintenance of the improvement or other right-of-way use hereto _ <br /> --»�'�A� aPPlied for and lurther agrees to remove same uPon notice from the _ <br /> Approved f Ccnslryi1ction Date Ciry and to replzce pubtic property damaeed thereby. _ � <br /> � �� ��'� �� <br /> ����l(,��' "'`" �� � ���- 3- � 3 - �4-� - <br /> FINAL INSPECTION �� ��1e �� <br /> AfProved as Constructed �� Signature ol AGP��cant Date � . <br /> everett PUBLIC WOR'<S DEPARTMENT � WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIIJ , <br /> 780 DAYS OF DATE PERMIT IS 153UED AND THEREAFTER IS TO <br /> �� 3200 Cedar S�.reet I BE DILIGENTIY PURSUED TO CGtdPLE1l0?I. TriIS F�R�"Il '•tAY f:� <br /> Ev�re�t WA 98.'Ot CA��iCELLFD BY THE CITY UPON NJY ETOPf'FGE OF WGRfC ON TH15 <br /> Phnne: 259-80t � pRi7JECT OVEF. 50 D:,'IS DURATIOt�. <br /> i <br />�r�' _ <br />