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-- - , <br /> �. <br /> � � <br /> � -�:� <br /> I .yT� <br /> i };S <br /> � •S <br /> i <br /> I <br /> � <br /> Date_i«��"=� v��m��wa,xsvc�;��� � _ CA"l `3li> ���' ^,r.�. <br /> L I - <br /> Applica�ion For eie9 ocPi.b _- � - <br /> P� BLIC WG���iI�S PERIIn �T PubTolalFepFee S — <br /> LessAovl.Fee Pai� � '-�1 <br /> Print or Type Only a�i���eo�P 5 2� � <br /> ,��eC' � T�5 P� �x ��� �i!tPr 9�a�� �a <br /> Owner MsilingAddress City Zip phone � �-�' <br /> 3��-n3� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 1 ��� ��I` � L J 1 �� l ��C�� 1 ��'� i � <br /> Prolect Address(it known) � �4!� � _" ���Lfi' .f F � <br /> � <br /> Attach foui (4) copies of plans tor proposed v�ork- Draw to scale and note ihe lolloc✓ing as applicable: � <br /> • Property Lines i Centerline of streel � <br /> O Outline and dime�sions ot aii existi�g and • Indicalc North <br /> proposed s�ructures on�he lot � Show any proUosed qradin9 changes <br /> S Existing and proposed utilities ! Show measurements � <br /> DO NOT WRITE BELOW THIS LINE o <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shal�be made 24 hrs.in advance- phone 259•8810. � <br /> 2.All work shall 6e perfcrmed ic �ccordar+ce wi�h ihis permit and current Ciry of Everett Design and Co�struction <br /> Slandards and Sp2ci(ications. <br /> 3.Call Location Underground Service 4D hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � � <br /> � nri.i f�Fl('dJGG TIV TI1�- DRIVEI'iAY CI.JT i`II.I.`:iT F:E -r,s��;=r;o�.�cn <br /> `1 THC �'LIBL.i L" IJOf I':5 I N�"F•ECTf iE� � <br /> ,IJS� F'I.1gLSC DR� NALiF iYSTF11 fi'i I'F:O�'i[if-[7 I nl; U�t�lil i�I.IT4:; <br /> �li'Jl' LOT r�i(1DE CHAh.!GE� Ml.�:�'f EsE AF'Ffi0VE1� 1;`r �' ;1:- i <br /> -'UFiLIr �.JORI;; IPI;F�ErI'0��, � <br /> . 'L-EF' CI 'Y R i F�[-L.Tf; CLE/1N AT f1LL. l"IP1E� � <br /> � il'�lSTALL lJ(ll'Efi Y.O;(�S TO 6Rl1UF (1T '1'HE I-i�Ui i C7; i� � „� �"TTC)I�l <br /> "I(11.C SUkF Df-.T VE6J(11'c (1RE COh'IFL[TEL.1 C UF[t'il ] � � ii�::t: � '� <br /> I:� ( iJIVCi f1N IHF�i <br /> � � �` f1f\^I(1GF TCi T4F Cfif.f+ (11,!17 �Tr.r:R!Cil l UiL.J �P i- !� '.I,:E_C � <br /> � �"�:'.. ��' 1Si'lll_�� I�;-lj.� 17 � I_IS' ( � �r,i II I� . <br /> . .. . I -. ' I , <br /> ACKNOVJLEDGEMENT OF CONDITIONS I <br /> The undersigned owner/app6cant here�y agrees to hold and save haim- <br /> — Icss the Ci�y ol Everett from any and atl claims for damages, costs. <br /> � expenses. or causes of action ihat ma arise because of installation <br /> d�9 � ��� O ,/1 � and maintenance ol ihe improvement or o�her right-of-w2y use hereto <br /> C� �. CJ• ,-,//G•/•J applied for and further agrees to remove same upon notice Irom the <br /> Approv�=d for Con rurtion p2�e Gity and to replace public p�operry damaged lhereby. <br /> FINAL INSPECTION D:ite �i�G"`-7 ���"' �D'� <br /> Approved as Conslructe�' Signature of Appli ant Date <br /> evrrett PUBLIC WORKS DEPARTMENT N'ORK AUTHORIZBD BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cetlar^•reet 180 DAYa OF DATE PEflM1T IS ISSUED AND THEREAFTER IS TO <br /> Evere�t,N'�.,;G201 BE DIfJC:_:JTLY PUHSUED TO COMPLETION. THIS PER(�.�.IT MAY BE <br /> Phone:259-8810 CANCELI.ED BY THE CIIY UPON ANY STOPP�GE OF WORK ON TFIIS <br /> PROJEC���OVER 90 DAYS DURATION. <br />