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_ _ ____ _ _ <br />� � <br /> s: <br /> � <br />� <br /> ; <br /> Date��y " /Z S <br /> 0 �'uhLc Works reimil r <br /> Application Fur oltlij o`o�.`�� � '�'-" 7 �'. <br /> PU�LiC WOR4CS PEl�fVl1T' Put�TotolFeeFe� S - , <br /> Less FDPI Fue P�iU S_� <br /> Print or Type Only I Belance Itue 5_�2��-°- <br /> �, , (b,�)%-„c ���n� v� )�� —,�i�� J`� .ff= �vaie� �lcf za� 33�P3.,�S_ <br /> Owner Maifing Address CitJ ZiP Phone <br /> SG vv�,L <br /> ?pplicant Mailing Atldress City Zip Phene <br /> DescribeProposed Work _��LI � / a :.(.P, — C-dT � �/:PP.i �T�/C <br /> - '� <br /> Project Addre.:s(il known) �Q7�� � ��t�•�� - � <br /> � <br />� Attach four(4) copies of plans lor proposed work- Draw to scale and note ihe following as apUlicable: � <br />� i Property Lines • Centerline of sireel � <br /> • Outline and dimensions of all ezisting and • Indica�e North <br /> proposed structures on the lot • Show any proposed gradin� chanqes <br /> • Existing and proposed utilities O Show measurements � <br /> ��� DO NOT WRITF BELOW TFIIS LWE b � ' <br /> PER�iITCONDITIOIJS � I� <br /> 1.All�:alls(or inspection shall be made 24 hrs.in advance-G`���ne 255-8810. � ''� <br /> 2.All work shall be pertormed in accordance with this permi!and cwrent City of Everett Desic�n and Constnxlion � � <br /> � Standa�ds and Specifications. ��. � <br /> 3.(:all Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. S <br /> I`J'Y �_ IIi11�I��L:. fh� TI'.i= DRIV�Wral' GUT I�I lSl pr_: ,F'-'RL',!�D � <br /> Li`( 'fl-il_. �'U[>LSG WORf:S 'iN�PEClC7R. � , <br /> � . U`�E: 1='UEtLIC DF;AINA��E SYSTEI�i AS 1='RC�VI.f.)Eli FCJR '�OWI�I�1='l.]!Ji�3. �� <br /> b, ANY I_U'T GRAUE CHAh,�GES rius�r rir_ AF'F'ROVED B`( "fHF i <br /> I U4+LIG tdORb,S If�l.'�'if ECTTOfGF i I"I : lllf i=1aU .li l_r�� l . : I";:Ur :�i.lbl � <br /> ' CF' C.i T`i' :�Tfi( ET'' CI t aW 4l AI I TM�S i <br /> T� I TF+LL 4JATtl. F!1 � � <br /> ii 'N.�: ��IIrE DG. LVf� �df���`!`: (-i{v-�. I f�Ii ..i�. �r. l ' � r LI_�: 1 „!�_.I'�il„�. I <br /> 1i�:i�,;'7 � 1� pl`I II �� r-., � <br /> �m% <br /> � I <br /> AGI(MOWLEDG[MFP1T OF GONDITIONS � <br /> The undersigned owner/applicznt hare�y agrees to holtl and save hanm <br /> — Iess the City of Evere�t Irom any and all claims lor damages. costs, I <br /> ' � eapenses. or causes of aclion that may arise because ol installalinn I <br /> �L�� �/_-. � �� �7� and maintenance of the improvement or other right-cf-way use he«�lo <br /> C _ apF,lied for and lurther agrees to remove same upon notice fiom ine <br /> Approved for s c ion Date Ci a d o repla e p hlic G�operty damaged thereby, <br /> � � '���� � , /� � Li0 I <br /> FINAL ETION � � ale � ' `r��� <br /> Approved as ConStructed ign ture ot p icari( Date li <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN '�� <br /> everett PUBIJCWORKSDEPARTtdENT 180 UAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO ' <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COf�1PL[TION. THIS PERMiT fdAY B[ <br /> Everett,WA 98201 ChNGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> J Phone:259�8810 pROJECT OVER 90 DAYS DURATION. <br /> I <br />