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I <br /> J <br /> Luid_..u�.�=��; � Pu01¢War4s Pcrmi�n ���p (����' _ � <br /> �l(J��IC3�lOf1 FO�' ( 61d9.Dep�.x �7 / � tl--( �� ' <br /> [ ! <br /> P U Q�e� '�t�0 R�.� F.a E ry.t Y�� M��� Public Works feo <br /> U � � TolelFae S � <br /> ` Les,ApD�Fee Paitl $ <br /> Print or Type Or�iy �a��,���o�0 5 �J-��— <br /> � ?_r� c�,,� � �,,,� 1, �,� ��, . rir s� �� : �� �r .��r��:rz�> � � � -�»o <br /> � Owner MaJing Address " c> Zip Phone <br /> cG�-� <br /> � Applicant Mailing Address Cily Zip Phone <br /> Iii �[ <br /> Describe Proposed Work _�„((,/ . l,i� /' . �_'1 ��[L f�n l�7 /�l< _ _ <br /> 'th � <br /> Proiect Address�if known) /���/C� ' �n —.O.E'. S� (� <br /> r <br /> Atlach four(4) cepies of plans loi proposed work- Draw to scale and note the following as applica6le: � <br /> tl Property!ines • Centerline of street /�A <br /> • Outline and dimensions of all existing and O Indicate North v, <br /> proposed structures on the lot � Show any proposed grac� ig chan9es <br /> • Existing and proposed uhlities O Show measurements � <br /> �� <br /> DO NOT WRITE BELOlNTH15 LINE � <br /> PERMIT CONDITIONS <br /> 1. All cal�5 for inspeclion shall be made 24 hrs. in advance- phone 259•$$�$. � <br /> 2. All work shall b�performed in accordance with this permi� and current Ciry of Everet� Design and Consiruction <br /> 8t,:��dards sna Specifications. '. <br /> 3. Call �:.cation Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1-800•424•5555. � I, <br /> � , .r. . . . _ � : . . , I_i..� . � �i <br /> ��u»!. zc �r;nz�vnr��: s•;� r�r�� r�s r �;c��.� <br /> �-rr �;FFiL�L- rFlAl,ir,r:.� rn.is-r �r rar•F � <br /> 'c t40R1:;; TPaSFv:r:t-c,r,.. � <br /> C7"!1' 't-i'fF?EET(� CLIi:.�N fi�T f�1i_L Ti:: � � <br /> i�l':1LL wA i "t=R GCXE: 1-�-1 i:;F��'l)iF_. i-1T l ; � I <br /> !iU'riC: :'i, . � � .. <br /> ACKNOWLEDGEIvIENTOFCONDITIONS I <br /> The undersigned owner/applicant hereby a�rees to hold and save harnr <br /> — less the City of Everelt Irom ar�� and all claims �or damages, costs. �. <br /> _,�/ � ))) expenses, or causes of action that may arise because of ins!allalion <br /> � � /���Gr'�� •��� /p� and maintenance ot the improvemenl or other right-o(-way use nere�o <br /> —�'� �'�' �J applied for and (urther agrees !o remove same upon :iotice irom the <br /> Approved ior Con �ruction Dale Ci�and to replace public property damaged thereby. <br /> 1 r ;�._ _ i%-r;- �l/ , '�i �L C�r��Zr;�r�����. l..n,t�x�'«� <br /> �" /� <br /> FiNAL IfJSPECTION ' �:� � Da�e �L�/ ���1 1.�'G'1i(._ 3 ` ��i�]� <br /> A,�proved as Constructed �Sia��e of ApP�icant Date <br /> everett PUBLIC WORKS DEPNRTMENT WORK .�UiHORIZED BY THIS PERMIT MUST BE STARTED WIThIIN <br /> � 3200CedarStreet 780 DAYS OP DATE P[RMIT IS ISSUED AND THEREAFTEF IS TO <br /> ' Everett, WA.98201 BE DILIGENTLY PURSUED TO C0�IPLETION. THIS PERMIT MAY BE <br /> Phane: 259-F3f315 CANCELLED E3Y THE CITY UPON ANl'STOPPFlGE OF WORIC ON TFIIS <br /> � PHOJEC-i OVER 00 DAYS DURATION. <br />