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' �35' i <br /> Date�IS P�e��wo,kz P�, `�`3 � �r <br /> Application For 61tig Dept.a � '�� '_ <br /> PUB�iG WORirS ��RMI�' PuhTot�Fec�ee � - <br /> Less Appl.Fec PaIJ S <br /> Palance Ouc S ?v �� <br /> Print or Type Only - — <br /> � � � �� ��' <br /> ,l ► � ' C�-��L�-���� I� 1 Cl )C I }����� ��,��-C`;�3�.� <br /> Owner Malling Address Cdy Zi;, Phonr-, <br /> AppliCan� ��lailing Adtlress C�ty Zip Phone <br /> � <br /> �_ 1� —}— ) /1� ,���/� /� ',-hI �/ <br /> Describe Proposed Work c �—iS I � LL.-lD �J� / !�L ,l�C <br /> Froject Address(il known) /aU�-3 � �v�/ �� sE � <br /> � <br /> O.tfach four(4) sopies ol plant for proposed work� Draw to scale and nole lhe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing �nd • Indicate North <br /> proposed sUuctures o�i ihe lot • Show any propos?d gratling ehenges <br /> • Existing and proposed utilities • Show measuremenis � <br /> r DO NOT WRITE BELOW THIS LINE <br /> PERMIT CO�'DIT�!ONS � <br /> 7.All cal�s for msPection;hall be made 24 hrs.in advance-phone 259•8810. � <br /> '..r,n��ork shall bV pertormed in accordance with this permit and current City of Everetl Design and Construction <br /> '�tandards an�:Specifications. <br /> :� Call Lo ation U�derground Service 48 hrs.netore you dig.TOLL FREE NUMBER 1-800•424•5555. � , <br />! ,, , i -i� � - cc. •� ,.�.�,,, ,�., . <br /> .� _'`!,I�I i.��l � •�r,: nr' FIJFI'i' J? I'�i.l � . �_ . 1 <br /> I `/ � I1E � Utll:f; llfl '.c TII�f � Ci 1� . O I <br /> U�E !'UFI If DFAItJACE S"�TFI°i A9 F'FOl'TDrCi f=f1F r��:Iii I � 'i1T`, , <br /> F1� �Y LOT �,I�tiDE CIiANluES ItUST E+F. f1PF'ROVED EY T'U: <br /> FUF�L.Tr !;IORI:S II�!SI='F.r,-fOR . � <br /> CFFF' C.T.I'1' BT�iFFTS Ct.�AP,I AT AI.L. TT.MES. <br /> I I`3TAI._I_ WA Fr L+OXFS TO CiRADE (1'f THC F_.�ID OF r �I ' I I I1�; i I`'!< ♦A <br /> ; I!Y'.r.: Sl1RE DFt 1'��l-l�lAY� F1R� COh1i-'LETELY !,UF�En 8C r��f"tl r� <br /> , � , VT�Q(: fJ�J rfir- �. � <br /> , , ;��� i- „ � � �� i� � f;,� � i , �;�_�.�.�� �- :,tll ��;E- �,�� i ; � <br /> , i . .� � � . _ . . , � . . . �if�� . .. � � <br /> :�CKN04:�LEDG[MENT OF CONDITIOlJS <br /> Tlie under�igned owner/ap,�licant hereby agrees to hold and save harm- <br /> �,./�� �� ic�s ihe G�ty of Everett from any and all claims (or damages, costs, <br /> ��� � expense�. or causes of action Iha� may arise because of installation <br /> � (..�; /`��j �` � Q and aintenar.r,e of Ihe im rovement or o�her ri�ht-of-wa, use hereto <br /> � � "'-"� � / �v ap i d r and ���ther a9rees to remove same upon nutice from ihe <br /> P.pProved tor Con ruction ���e Cit and o re lace �blic <br /> p p pfpperty damaged �hereby. <br /> �� <br />' r� <br /> FIIlAL INSPECTION Date _.��L <br /> App•oved ss Constructed �gna u e o Ap icaM Date <br /> � WOR AUTHO IZGD Bl' THIS P[RMIT MUST BE STARTED WITH!�I <br /> evei.��t PUBLIC WORKS DEPP.RTMENT 180 DAYS OF DATE PERAIIT IS ISSUED AND THERCAFTER IS TG <br /> � 3e00 Cetlar Slreet BE DILIGENTLY PURSUE� TO COMPLETIUN. THIS PERMIT MAY BC <br /> Eveic�t,WA 9820t CANCELLED BY THE CITY UPON ANY S(OPPAGE OF WORK ON THIS <br /> Phone�.:],9�E?810 PROJECT OVER 90 DAYS DURATION. <br />