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,. ` ,�. <br />�. � <br />�: - <br /> ;;,, <br /> ,N.,, <br />� , <br /> I <br /> V: ' <br />� <br /> Date �� � � P�e�,�wo�k:r�,m��� 88 ��� <br /> AppliCation For ( e�aq oco�.+ � �� . <br /> F��lBLI� �f:��RK� WE_fi�?�� G�� Pul�IicWorkSFae <br /> To�.�F�e s <br /> less Aop� Fee Pae S_ �' <br /> Print or Type Gnly o��,�=�o�� s �f�� � <br /> '� ���%'�i ,l -� � � �� i��=���:�� I'�'�11_a�l � I`�"��J 33�— �335 ��� <br /> E,_ Owner Mailing Address City Zip Phone � <br /> Applicant Mailin�Addrrss City Zip Phone �I <br /> : Describe Proposed Work �1 �� __ �� �Y'� `�'t r��� �L� �`�. , <br /> - � I'I <br /> PwjectAddresslifknown) �I�'� — �G�� L�� SC� � <br /> Atlach four(4�copies of plans for proposed worY. - Draw to scale and note Ihe following as applicable: � <br /> • Property Lines 6 Centerline of sireel � <br /> • Outline and dimensions oi all exisi�ng and • Indicate Norih <br /> proposeA structures on the lot •�Show any proposed�rading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NO-f WRITE BELOW THIS LINE <br /> PERN�IT CONDITIOP:o � <br /> 1.All calis for irspeeti�_ i shatl be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be per+ormed in acwrdance with this permit and current City of Everett Design and Conslruction <br /> Standards and 5��ecifications. <br /> 3 Call Locat:on Undergroun�S'ervice 48 hrs.before you dig.TOLL FREE NUMBER 1•860•424-5555. � <br /> q�.(1tdY C��IAl��'L;F .r,P.� -:: ���_ UFtT'-;Fl+lil7 t;'.Jl� i1i1(-�T E+f-_ F1F';'fi0V1"iD <br /> E` TI IE � ;_.I(_ �1Uf f.S II!' F�C;101:. � <br /> F� ..Ur ' i,�IPI fC TiFI(1TW( f�E ' 1 "T'�Pi Ai FfiO:'IU�G Ff]F [',ltI� 1;P'f?;.Il"':: , <br /> S. �dVY LOT GF,(1DE CHf1NC;CS t1U5T BF (1FI='ROVED i;l Thl;'_ � <br /> PIIRLIr 6�1DfiI::S IIV:;F�E�"T!�F;. <br /> 7.1•.� EP CJTI' :?TFI_ET;:i CLEAN :l'I' (1LL TIMEEs. ,. p <br /> E3. fIVEi'f(-1LL. 1df11F"F PC)XFS lC! 6FiF1DE (1T THF' �ND Ofi;.; � ,i;i;� ?fll'; ���f <br /> 9.ft(lf:E f',l�fE llFiIVEI!�(lY� (1F'E CUtIf ! E'fELY ('UFfED L'k.'F(1F,� � <br /> UFiVING �N 7HEi1 <br /> l:.i r1�1" nli' [ I:: T(l TIiC' l Ilfir� FihlTi 7 �irld��t I dIL I FF f-�LF'(IIREG ��i <br /> �U . i-', i � i.�' fl('.'� .�1.1� � �1;_ _���� I !;tl .��l I)I)�ii: � r'i•�-„ ��C� <br /> ACKNOWt EDGEMENT OF CONDITIONS <br />� The unde�signed owner/applicant hereby agrees tc hold and save harm� <br /> ��y� Ir.ss �he C�ty of Evere�t from any and all claims for dama9es. costs. <br /> i expenses, or causes ol ac�ion that may arise because o� installa(ion <br /> /'�� n�j�"��i� Q /G�g and mainten ce o' ihe imp�ovement or other right-oFway use herelo <br /> ��— appli d for d further a9rees to remove same upon notice from Iiio <br /> Approved !x Consiruction � Date City nU to �place pub c pr p rty damaged Ihereby. <br /> F,NAL INSPECTION Date . lYi L I�l� � b <br /> Approved as Cc�siructed Si na�u e ol Apphc nt Date <br /> everetl PUBLICWORKSDEPARTMENT WORK AUTHORIZ[D BY THIS FERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF OATE PERMIT IS ISSUED AND 'HEREAFTFR IS TO <br /> Everelt WA 98201 BE DILIGENiLY PURSUEC ) COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UNON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />