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r-- <br />� ' <br />� <br /> � <br /> Date ��� b'Q` r�n,��:wo�ksvo,m��. UL�—� •> � <br /> ApPlica!ion For ei:�n oco�.e���3�'- I <br /> PUBLIC l��R�C:S PERMIT °°�>��°W��k=F�o � -- ' <br /> ialal Fec <br /> Less ApPI.Fec Fla�J J�� <br /> Print or Type Only e��,�«o�� s .� �� __ <br /> i <br /> � � $-0?.�S I <br /> _ �'i C ��n s �.;,� !�.crn r.� )�Za -/GD*`1 S7`.(`� �dP/C�1�C�//�- 9�"ZD�2' ' <br /> Owner Mailing Address City Zip Fhone <br /> �CLl�. � ._—___._ <br /> Applicant Mailing dddiess Gty Zip Phone <br /> Describe ProPosed Work _�...;�,.) - . _.._��.���.,{.'-�i-�,.4 rs� - S//QG��sv���/ NA � J !'P ,. <br /> Project Adtlress(it kncwn� _ ��8�� - �O th G7i(:_��G_ � <br /> � <br /> Attach �our(4)copies of plans(or pr000sed work- Draw to scale an�: note Ihe ;,�Ilnwing as applicable: �� <br /> • Property Lines �R Cemerl;ne of street � <br /> i Outline and dimensions of ali existing and 4r ;�clicate North <br /> proposed strucWres on the lot 8 ;,h�v:any pro�osed g�adinc� changes <br /> O Existing and proposed utilities m Gho�+ measwemen�s � <br /> �annsirir�,�a•r.cir�. a:: <br /> DO NOT WRITE BELOJ� TFIS Llhc � <br /> PERMIT CONDITIONS <br /> 1.All c;:lls tor inspection shall be made 24 hrs.in advance-phone 2�3•3810. � <br /> 2.All work shall be pedormed in accordance with this permit and c�uect Ciry of Everetl Design and Construction . <br /> Standards and Specifir.ations. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FaLE MUMBER 1-800-424•5555. � <br /> 4 ,(1NY Cli(-\IIC�i fl�J lll': D;iP!hl�J(1Y f'lll �'ll_),; I L:- � FI 'Ii0'JI=�_ � <br /> F{Y THE FURLJf: ldf�F�f:S II•.�f�F'�[: (C�fi. <br /> i .,I1SL r-ur.{i_rc nr;r�rivny� ;;`(91E19 /1S FROViDFD FOR DObIIJ! �'OUiS . <br /> `r• .f1NY' LOT Gfif-ll?F CFIANC:IES Y•1U� 1' E�E AF'F'ROVED E+1' ll iE � <br /> f-U13LIr 4�101:1 :, TiVSPEr�'OF . <br /> ' . I::FEF' CI'fY S'fR .F.EI"S CLE(1N AT At_L TIh1ES. � <br /> i„ �IUSI'(1L_I_ WAiER FsOXES 'f0 .r,r-,nnr nr TFIF END OF CON;TFiUC'I"7i7P.1 <br /> >. r•int::r Sl.1RE DPi1:VE4JAYs nF,r:. COt9P'L.F.TFLY CiiRED BEFOFE � <br /> ll�tT�1Il![i ON 1 !-I�M,. <br /> ) �� '�F� Il1(�E TD TFIF CUF�F+ ANI) �IDFWFII f' WILI pc- r,ri �,IFt�D A <br /> i (! Ii:- �,�� fI.";�'(lOTfO�J Ilf Tlli. '"'I)'il..:[f !d(1�:�'c I) ;•T L� <br /> �CKNOWLEDG[MENT OF CONDITIONS <br /> ,� ,/yl,v Tcs undersiqned owne�/applican�hereUy agrees to hold�nA savc hnrm- <br /> ��� '"r less �ho Cily ot [vere�� Irom any and alt claims for damages, costs. <br /> .� � expenses, or causes ol action that may arise because of installation <br /> �_�%Z,� ..(,.��� 7 ��•L�57 and maintenance of the improvement or other righbol-way use nerMo <br /> f�� � applied (or and furlher ag�ees to remocc same upon nohce from the <br /> Approved for Con5lruction Date Citv and to replace public pioper�y damaged �hereby. <br /> F-�� W ( <br /> FINAL INSPECTION Date 7 L7 / <br /> J � <br /> Approved as Constructed Sign ture o Applicant Dalc <br /> everett PUBLICWORKSDEPARTMENT WnRK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATC- PERMIT IS ISSUED AND T!IEREAFTER IS TO <br /> Everetl,WA 9820t BE DILIGENTLY PURSUED TO COMPLETION. THI£ PERMIT MAY E3C <br /> Phonc:259�8610 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />