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, � <br /> j <br />;� ���� <br /> Y.� <br /> � '���'�`�. <br /> ,i <br /> ��� �� ��� PpblicYlorNCP�!rmll< </ �� �" � � � <br /> Date�_�;_���C> : <br /> � �j�� <br /> ApPlication Fo� o�ee oeoi-�� �-..� . ; <br /> , ,,� <br /> PUBLIC WORK� i��RMAT P�����W�,�=FeC -- ;_,� <br /> Total Fea S �� <br /> Les:Apoi Fee PaW $_�_ V <br /> Print or Type Only e;,�.,��„o��� s ���U" I • ;� <br /> � �t� <br /> �i�'�'.l�'�� f� -:S 1�'� ��� � ?� r'l�) 1, �� 1 �lPl� ��7�- �����:�� <br /> Owner Mailing Address Gity Zip phone ' 's <br /> •( <br /> _ �3�� �_;� <br /> Applicant Maili�.� 4ddress City Zip Phone <br /> �/� �t-� ���/�/� �/y�;, �/ ��� <br /> Descrbe Propcoed Work �-��V� �JL,1� ��� 1 r,�)� I J L I"C {V^J� ,�" <br /> � <br /> — i <br /> Prolect Address(if known) __ �� � z T — ���v�1. SE � <br /> � <br /> A�,tach icur(.) copies of plans lor proposed work- Draw to scale and r.ote ihe lollowing as applicable: e <br /> • ?wperty Lines 0 CenlerLne of streel /A <br /> O OuUine and dimensions ot all existinc� and • Indica�e North �r <br /> proposed struClures on the lot • Show any proposed grading change;, <br /> • Exis�ing and proposed utilities • Show measurements � <br /> � DO NOT WRITE BEI.OW THIS LINC-m� � <br /> PEFlMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedorrt�ed in acccrdance with this permit and current Ciry of Everett Desiqn and Co�struc;ion <br /> Standnrds and Specitications. , <br /> 3.Call Location Underground Service 48 hrs.betore you diy.TOLL FREE NUMBER 1-800•424•5555. � . <br /> �4.F1NY CfiAl l� f i�! l f-IG UFi T Vk:�Ari`( Cl l f PIiJ� l [ I_( r iF'I'f�0y�l; � ' <br /> E'1' TI-IE Fl�li_IC ld[�t.:h'f: r�ISF'ECfOR. <br /> � .l.)=iE ^UEt1, tC DFi(1:[N(�f= SYSI'F_��I G1S �'FOVIDF_D r ��r� i70t�)�I� 'il' � I '; � <br /> ;lhll' L OT Ghi(1l]E Cf lAhdGCS h1LIST BC !lf'PROVFD }ll TI I[ <br /> "'U}31...T.0 4JOfiI::S T.NBi'ECTOF'. � <br /> '. t,( f F' CITY S"fREF f� CL.EAN qT AL.L 'fTpM1E=S, <br /> 71 I i I (1L.1.. IJATf"�' RfJ{I-S l(l G�(1DF AT THF_ F_ND �F Gi ii�!' T :l!� 'T f r7i : � <br /> I �111:f �LiF.1= D�,TVEbJAY`J (1RE rp�,IFLf_TELY ['URE"IJ FtLf'UF�:E <br /> i;r,.r��iive niv ii-i,.ri. � <br /> � O . A��v nru,r,ri . ro THE OI�Rk' (iPdD ;�SAFI�lALI:: WT.LL. FiE F.[i � iiCi� <br /> TO 71IE Srl f r,! �1r:;-r:[nN r]F TF�E :'IJBI._LC UIORt::S DE�; f . <br /> .% �s;�,a t`� /Le-�h:rv��' �/�,:�u ZG,a,,. bG-a�Z c� �c�� <br /> ACKK,OWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby agiees to hold and save harnr <br /> / less the Ci;y of Everett trom any and all daims for damages. costs. <br /> �(3D ➢� __ / expenses, or causes of action that may arise because of installation <br /> ��//��, � -o and maintenance of ihe irn rovemenl or o�her n h�-of-wa use heretn <br /> �� ��"'" `�"' G'�' "- � �- -��� aUnlied for and furiher agrees to remove same�upon not ce Irom ihe <br /> Approved for Constnicticn Date Ci�y and to reF�lace puUlic property damaged lhereby. . <br /> FINAL INS�ECiION Da�e I �� _ _ /Q- 5�• {�i _ I <br /> Appwved as Ccnstructed Si�naWre of Ap licant Date <br /> cvrmct PUBLIG WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITFIIN <br /> � 320GCedarStreet 180 DAYS OF D.�TE P[RMIT IS ISSUED AND THEREAFTEfi IS TO <br /> Evereit,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phonc 259-BB10 CANCELLED BY THE CITY UPON ANl'STQPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DUf?ATION. <br />