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� <br /> , <br /> k. <br /> �� <br /> ,� <br /> .:W <br />�tk � <br /> � <br />. -`�- O � ��� <br />` . Date�� C��% r�m��wo�k:Pe, �.5� � <br />+ Application For �'tl9.o�P'.»� � I <br />� Pl�g�.IC WORKS PFRMIT v�"���W�,ksF�� � <br /> �oiaiFee � � <br /> Less ApPI Fee Paid S_ ��+r':! <br /> Print or Type Only B„�=�o�� s '-���— "! <br /> � . f���� � �',1��(� _ P�� �� �__:����,�� �'?' � � � � ` t���� I ( �� � <br /> �wner � Muiling Address Ci�q 1 7'p� , Phone � � � <br /> �.�►'��e - --- -- <br /> Applicant PAailing Address Ci�ry Zip Phone <br /> Describe Proposed Work ��"�,�_,.���XJ l C�J c l�X 1� �� �I, <br /> — - � � <br /> ProjectAddresslif known) /��� 7 _�__ �d b�� !/d� .5�, <br /> Attach four(4) copies of plans for proposed wo•�:� D�a�.v to scale and note lhe lollowing as applica6le: � I' <br /> • Property Lines e Centerline of street � � <br /> • Outline and dimPnsions of all ex�st� � and • Indicate North , <br /> proposed strucWres on the lot • Show any proposed arading changes �, <br /> • Existing and proposed utili�ies O Show n�ieasurements � . <br /> DO NOT WRITE BELOW THIS LINE � I <br /> PERMIT CGNDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in adva�ce-phor,e 259•881 Q � <br /> 2.All wurk shall be peAormed in accordance with this permit and cu«ent City of Everett Design and Construction <br /> Standards and Spec�fications. <br /> 3.Call Location Underground Service 48 hrs.oefore you dig.TOLL FREE NUMBER 1-800•424-5555. <br /> .^,'IJ`r CIiANG[: Ii;l l'tiE DRtVE!JAY CL1T I•I'Js;T cs� I'��•Pl;n! Efi � <br /> � :�'i iHE F'UbLSC ldUf?i'-.:1 ItdSPECTC7R. � <br /> `i .,IJ,".:E f'�_IEL.:[C DIt(1INA['�f- `[iYSTGl9 (1S f'fiOVIDFED FOFi (i0l9NSF0UTS. <br /> , (1Nl' LO'' FF:(-1DF CI IP�I�d�E'� MlJST P�E FiF'F'ROVE� Bl' TFIE <br /> ('UE�I_fC lJl;�ik:i INE+F'Ef;l"Qfi. � <br /> ' . i FE�' CI fY S'fREc CLE(1N (1'f r-1LL '1'IY9CL'. I _ <br /> tNSIAL.I tvl�TFFi F�i'CF.S 10 �`R,.aDf-: AT TI-IF �hID Qf= COP•!S1'F:Ur?rOt�! �r� <br /> t1Al .I �t.IFiE Uf'tTUE6 F1YF� (1FE COMF'LE'iELY CUREll �sE FOIiE � <br /> , r��� rdr �aiv THE t9 <br /> il n�, nrc Tfl ' flh. Cllfif' (il`.I)1 � ] DFbJ�iLl ldTl � rl r� r t�J '!-:i� <br /> . . , � l'. . ;'�1�JP.i fli� l�i-I( ` IIi:L.�(f II tf;l�,` '� � . � <br /> �CKNOWLEDGEtdENT OF CONDIT�ONS <br /> The undersioned owneUapplicanl hereby agrees to hold and save ha�m� <br /> — less ?he City o� Evere�t Irom any and all claims for damages, costs <br /> g��gF �� expenses, or causes ol action that may arise because of installa�ion <br /> �_ /� �q_ D n� /q. �1� and maintenance ot ihe improvement or other ric�M�ol-way use hereto <br /> �f� � s- apphed tor an further agrces to remove same upon notice Irom the <br /> Approved foYCOns�ruc ion ate <br /> � / � '� ; � / Ci�y a to re ce ��blic property tlamaged thereby. <br /> / �:�� % ', ``- . <br /> FINAL�INSP T ON � Date � �' 3 �� <br /> Approved ae.Constructed Signa ur of A plicant Date <br /> everet[ PUBLIC WqRKS DEPARTMENT WORK� A THOflIZED ElY THIS PERMIi MUST BE STARTED WITHIN <br /> � 3200CedarStreet 130 DAYS OF DATE PERMIT IS IS3UED AND THEREAFTER IS TO <br /> Everett,WA98201 E�E DILIG6UTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> C4NCELLEU BY THE CITY UPON ANY STOPPAGE OF bVORK ON THIS <br /> Phone:259-8810 PROJECT OVFH 90 DAYS DURATION. <br /> �. �� <br />