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0 <br /> � ///y��' Jr.�` PUUIm t"/o�k;Pernw s <br /> �� y � <br /> DateJ�� Bltlg DapL• <br /> Applicalion For — <br /> �UgLIC WpRKS PERMIY PubllcWorkSFce � ;��._ <br /> intal Fea <br /> Less AOoI.Fce Pa�d g! '—�� <br /> B�IpfiCOOV9 `� � <br /> Print or Type Only �g/n / <br /> �>�OC�1� <br /> SiAN � R�� � Ac1 �= 1c. � �N� ' oi�- i' r� o� il �(. S � t�=c.�.c VU� <br /> Owner Mailing Address <br /> Ciry ZiP Phane�r� S— I� i� <br /> 5 7"t�`�� r CiIY Zip Phone <br /> Applicant Nailing Address <br /> Describe Proposed WorY. <br /> �( cVv, Ri„sli�circ� LUr � 6 <br /> � <br /> 6 O /O ` ��• SE - � <br /> Projec:t Address(it known) � <br /> AL'ach lour(4) copies of Fla�is for proposed work- Draw to scale and note�CQolterline of sheet able� � <br /> • Property Lines • Indicate Norih <br /> i Outline and dimensions of all existing and � ghow any proposed 9rading chan9es �p <br /> proposed sVuctures on the lol � g�,�ow measurements �i , <br /> O Existiny anc: proposed utilities Odp� <br /> � DU NOT WRITE BELJW THIS LINE � <br /> PERMIT CONUITIONS � <br /> �i. All calls tor inspection shall be made 24 hrs. in advance- phone 254•881 5. <br /> 2. All work shall be performed in accordance with this permit and current Ciry o( Everett Design and Construction <br /> Standards znd Soecificationa. �•� <br /> 3. Call localion Ucuerground i.:s�vice 4B hrs. before you dig.TOLL FREE NUMBER 1•E300-424•555 . � � <br /> � <br /> � � <br /> �; <br /> �D<}- G�Pa r�.� �� Z � /�-�Zj .. <br /> � <br /> V/ � ~ <br /> � � <br /> � ,=i ,. <br /> ACKIJOWLEDGEMENTOFCONDITIONS r� ; <br /> c <br /> The�r�dersignetl uwner/applicant hereby agrees lo hold and save harm- �,-�, � <br /> —' ;ess the City of Everett from any 2nd all cmims tor damages, costs, H __ <br /> expenses, or causes of action that may arise because ot installation � c <br /> ^���. �' and maintenance ol the improvement or olher righbol-��ay use hereto J .. <br /> � �LE� �—�y��Y apPlied for and lurther agrees ro remove same upon nolice Irom the <br /> � Date Ciry and to replace public properry damaged ihereby. <br /> p�ed for C�nstr�cUon _ <br /> G�rzo fJl t�"�,R.�� 3 ` 13 `� � <br /> Date � Date � <br /> FINAL INSPECTION Signature ol Applicant :,: <br /> Appwved asConshucted y�ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN `. <br /> t <br /> everett PUBLI" WORKS DEPARTPdENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO _ <br /> � 32p0 Cedar Street pE �ILIGENTLY PURSUED l0 COMPLETION.THIS PERMIT MAY BE <br /> � Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK QN THIS <br /> � Phone: 2 59-8815 I pf70JECT OVFR 50 DAYS DURATION. <br />