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, <br />�{H .� <br /> r` � ��'.���:;. <br /> ; <br /> II I ''� <br /> j '�:,� <br /> Datei�l�`CT� r��ei��wo�kzFmmn. �U �.350 '.. <br /> Appi'cation For em� oop�., � � �, <br /> PUBLIC WOFikC� �'F_RMIT P��,°�W�,ksF�� -- =' <br /> m�ai F�� s <br /> Less FpPL Fee Pnld S <br /> Print or Type Only e,�,��e o�e S <br /> �1��XY�! a ���(�'�'_ i=2� tr�x 1C'f'� �� 1, �I � �11 ���'�;3S <br /> Owner��- Mailing Address City Zip Phone �I �� <br /> Applicant 1.1ailingAddr�ss City Zlp phone I �.. ,.{� <br /> Desc:ibe Proposed Work _`��� I--LJ l �(� �^c���' ) �^K �' <br /> Prolect Address(if knovm) /D 7i5 - /D ���,P .ti� � <br /> i <br /> Attach tour(4) copies of plans for proposed work- Draw to sczle and note the following as applicable: �a <br /> • ProFzrty Lines v Centerline of street �� <br /> • Outlir,e and dimensions ol all existinc� and • Intlica�e North <br /> propos^A siructu�es on the lot • Show any proposed�r��ting changes <br /> • Existin9 and pwposed ulilities e Show measuremenis � <br /> DO NOT WRITE BELOW THIS LIN��� � <br /> PERMI7 CGNDITIGtiS <br /> 1.All calls foi inspeclion shall be made 24 hrs.in advance-phone 253•8810. � <br /> 2.All work shall be performed in accordance with ihis permit and currenl Ciry of Everett Deciyn and Construction <br /> Standards and Specitications. . <br /> ' Call Locaiion Underground Service 48 hrs.be(ore you dig.TOLL FRFE NUMBEFi 1-800•424•5555. � <br /> , r`�i�lY L;Ii(1NCii:: :[t�l TiIF_- DFi:[�i�4•J!1`! CUl r•IUSf BFS (lF-'FFiO�I�?D � <br /> L{1' f-'F F'UP�LT.(: t4URlt5 IId:�F'ECTOFi. <br /> `i ,USF: � �JHLI .r, DFfIlINAGE SYSTEi9 (-1S FFtOV.iDED FOS DO!4i�ISF'OUTi; . <br /> _ .;tlV'r �DT Gk(1llE C'rIAN�ES h1UST f.�E F1PF'RQVED BY 'fHE � <br /> ;=�UBI_T .r, ldi�ht::S Lf�I,PF?L'TOft. � , <br /> 7, f::FEP CITY S�'(REETS CLE(1P�I AT ��LL TII'IE�'. <br /> _] , IPI;,1'ALL 4dAi'1=ii 1?OXF:.-^, TO GRADE F1T T1-IE END OF COIVSTFUCI'Ii?h: � <br /> "'. hIAI::E SIIRE: fJR1:VEtJF1YS AF:E COMF'LETELY i;{JFiED BE::rORE � <br /> 1)F:i:V:lldl:; 0�I T{?'r-t'I . <br /> 1�:,. ;al�.l1' DAM(1fiE T� TFIF CURL• 11Ni� �;IDF.:Id�l f.. P1ILL N:E I ' f �TI;I:1::� � <br /> �i i, l H rll�1:" ` r1r;T 1 C�l�l r)F i I�I _ r�i_i�ii_ ' � � I�.ipF" , r,�L=f �i� <br /> i1CKNOWIEDGE4i;: v i OF CONDITIONS <br /> Tl�,e �mdersi9ned owneqapplicant hereby agrees to hold and save hann- <br /> / less ihe Gry of Everelt Irom any and ail claims for dama�es, cos�s. <br /> Y//�i�t ',• � expenses, ur causes of actinn �nat vay a�ise because ot installation <br /> ,.,,�} — �� �� � �� p and Intenance of the improvement or olher right-of-way u:�z hereto <br /> �— --+ ��� �� appli for d fur�her ag�ees to remuve same upon notice from �he <br /> ApproveJ for Cons�� ction Date Cit nd � eplace public p� erty damaged Ihereby. <br /> FINAL INSP:CTION Late �> 'G d <br /> ApProved as l'onsiructed igna i e ol Ap icant Date <br /> everett PUBLIC WORKS DEPARTMEWT W�R AUTHORIZ[D BY THIS FEPMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATF PERMIT IS ISSUFD AND THEREAFTER IS TO <br /> Everclt,WA 98201 BE DILIGENTLY PUf7SUED TO COMPLETION. 1 HIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITI' UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 40 DAYS UURATION. <br />