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_ _. <br /> oate�'_l(�t �S P���<Wo�k�v�,��,��,' f'(7' 3s�-i <br /> ApG�ication For emp.o�v�-• �-� ����__ , <br /> PUfB�if: WC�RKS PERMIT P°°��°W��°sF°� — ' <br /> Total Fee $ <br /> Le55Appl FeePaitl S <br /> Print or Type i�nly e,�,�«o�� s ���— <br /> �� � lr���� t-''�� ��� '7DF rfl���i I > > -���-���� � <br /> Owner Mailing Address Gity Zip Phone ��. <br /> Applicant Mailing Address Clty Zip Phone <br /> Describe Proros?o Work ��^• ����� W�` '---����� ��'�-��� � __ <br /> Pro�ec�Adtlress(if known) /v��✓ '� / Q �,��'S r � <br /> � <br /> Attach �our(4) copies of plans for proposed work- Draw to scale and noVe ihe following as applicable: s <br /> O Property Lines O Ceeterline ot :treel ♦^ <br /> � Outline and dimensions of all exis6n9 and 41 Indicate North V� <br /> proposr.d strur;ures on the lot 91 Show any proPosed grading chan9es <br /> • Existing ano proposed utilities • Show measuremen�s � <br /> �o <br /> DO NOTV/RIT.f. BcLpW THIS LINE <br /> PERMIT CGNDITIONS Q <br /> L AII calis for inspeclion shall 6e made 24 hrs.in advance-phoce 259-FS81 O. � <br /> 2.All work shall be peAormed in accordance with this permit and ci�rrent Ciry of Everett Design and Construr.tion <br /> Standards and Speciiica!ions. <br /> 3.Call Location Undarground Servica 48 hrs.before you di9.TOLL FREE NUMBER 7-800•424•5555. � <br /> �; .,r1P11' .r.I�ir1PdC;� LI�� l � �G nF;IVE��Illy .r,�iJl' PIiIS�i Blc i�l=�l='Ii0'-rEG <br /> � Ti!r: "UI:;LI[ 'lOf�1.F; fl�l''F'ECl �ik: � � <br /> � L'S� 1-'JF+I_IC U�(1I�J(1C,E bYSTEl1 !1S r-rcwznr� F'OR r��t41i ! "'U;!I"" , <br /> , �NY L.QT rRF1Dk CI IARICiEf-,' h1L15'f FiE AF'F'RUVEU Bl' i I I(. <br /> f'IJF1L.tC l�1pRI:S :[N:�F'CCT01't. � <br /> ', fi:EFF' Cl�fY S'fRLET� CLGAl�I A`f (1LL 'fTP1ES. <br /> �; . IhdSTfll_I_ ltlATF^ E:O;;FiS 1'0 GFiADE (OT 7'I-IE END OF i;OPi,^,T(:l'_'TT�:11'! � <br /> 'i.M(1F:E E�UFi[ DR I VE4J(lYS (1FE COMF LETEL 1' GUFtFD �LF[?P�f � <br /> U':IV [i�1� JN l'IiFI I <br /> I_'_� (11 �" 'l(1'1( f�l: lfl IIIf" i .,ll }: (lhll : l�Eli( I I I•I):I i )3E' I � I'r1fF:�'I_i <br /> . ;�!'�� :'i� �i `" 1 � i�Ji I '!�I� !I�'.� � ' I I��:��� . �.'f.:' . � <br /> ACKNOWLEDGP_I�1ENT OF CONDITIONS <br /> The undeis�ned owner/apUllcant herehy a9rees to hold and save harrn- <br /> � � � — less �he City of EvereU Irom any and zll claims for damages, costs. <br /> ' � expenses, or causes of actior. ihat may anse because of instaliation <br /> ,�,rfi ����� L,y ��� p� and mainlanance of Ihe improvement or o�her righFOFway use hereto <br /> ��� � -� ����� � - app�ie lor a d furiher agrees to remove same upon notice from ihe <br /> Approved (or Cons ruction Date Cit d to �lace pu6lic proper� dama9ed thereby. <br />' FINAL RJSPECTiON Date ' �- L- —"1 13 �8 <br /> Approved as Constrocted Signati e ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STPRTED W�THIN <br /> 180 DAYS OF DATF. P�RMIT IS ISSUED AND THERC;�FTER IS TO <br /> � 3200CudarStreet BE UILIGENTLY PURSUED TO C, `MPLC-TION. THIS PERMIT MAY �E <br /> Evcrett.WA 98201 CANCELLED P�'THE CITY UPON .4NY STOPPAGE OF WORK ON THIS <br /> Phona 259-Ei810 pqOJECT OVE�; 90 DAYS DURATION. <br /> _J <br />� <br />