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Date�,�=�;� v����wo�k�Po,m,�= �`�5� _ <br /> ApplicationFor emo.000�.r � <br /> • ��/1�'�/ 1 Y �,/n^� r�R�'� Puolic Wores Feo <br /> Tolal Fea g �� � ti� __ �. <br /> LossAOP�Fce Pal: $_. �i <br /> Print or Type Only 9alanw Uue $ �—�' U 0_ �I <br /> Ei�''!E� 5�� I <br /> � TAIJD�lR D P� e 1 r- i N W ���f1 P i3���r il9- r�A�/ S r_]3�,�.LEUt,��� • ���. <br /> O.vner Mailing Address Cit <br /> Y Z�P Phone <br /> _�� � t; <br /> Applicant Mailing Address Ci� � — — <br /> ) Zip Phon? <br /> Describe Proposed Work � v Y �\ t S� � ,�_C � L.h�r .�,� S <br /> Project Address(if known) _ �� lo / Z /b — Yr .S,L � <br /> Atlach four(4) copies of plans tor proposed work- Draw to s^,ale and note the following as applicable: � <br /> �L Properly Lines • Center!ine of street � <br /> • Outlme and dimensions of all existing and • Indicale North <br /> proposed structures on th� lot 9 Show an � <br /> y proposed grading changes <br /> • Existing and propos?" utilities • Show measw,:menis <br /> O NOT WRITE BELOW THIS LINE �///��� <br /> PERMIl�CONDITIONi; "� � <br /> 7. All calls tor inspection shall b�made 2a h�s. in advance- phone 2S9•881 5. � <br /> :. -,i s..:��;hall be perlormed i�.i accord.�i•-e wi�h this permit and curr�nt Cily of Everett Design and Co:�::�uction � � � <br /> Standards and Specifications. <br /> 3. Call Localion Under9round Service 48 hrs. befcre you Uig.'fOLL FREE NIJMBER 1•E�00•424•55�5. � <br /> � r <br /> � <br /> � H ' <br /> � J' C <br /> � V t' <br /> C! �. <br /> � � I: <br /> y :. <br /> O C <br /> C <br /> F,CKNOWLEDGEMENT OF CONDITIONS � ' <br /> The unders��,gned owner/applicant hereby agrees to hold and save harm- � I <br /> :ess ihe City uf Everett Irom any and all claims for damages, cosis, � <br /> �-- expenses, or causes Of aClion that may afise ber,ause of installation � <br /> ���� � ,��!�� and mafitenance of the impiovement or other righboi-way use hereto <br /> Ap oved orC ns: ction Uate applied for and further agrees to remove saTe upon notice �rom Ihe - <br /> City and lo replace public property damaged thereby. <br /> 7,�� e ,1 <br /> [/V� �� ��g� r� . <br /> FIP�AL INSFECTION ,y(�(�� `-� � <br /> Approvetl as Constr�cle.d �"�`' �� �" �-- `IR� I 3 �4 <br /> � <br /> Signa?ure a ApPGcant. Da1e � � <br /> rverett PUBLIC WORKS DE .\RTMENT WORK AUTHQflIZED BI THIS PEFMIT MUST BE STARTED WITHIN ' <br /> �� 3200 Cedar Street iP0 DAYS ('F DATE Pl'RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98?_Ol BE DILIGEN�LY PURSUEI TO COMPLETION. THIS PERMIT MI'.Y BE <br /> Phone: 259-88?5 CHNCELLEC BY THE CITY JPOU ANY STOPPAGE OF'NORK ON THIS <br /> PROJECT OVER 50 DA'!S DUFiATIO�J. <br />