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_ _ �' <br /> + � <br /> r� , <br /> �nf /n� <br /> Date��� �� PUD'.cN'mksPormc'i�r �✓ � " � <br /> � Application For r,�a9.o�p�.=.�5.���f 77�0 <br /> PUBLIC WORK� P�RiViIT P°�°°W���=F�� -- � <br /> Tolal Fm 5 <br /> �es.FpPI.Fee Pala 'J T , <br /> Print or Type Only Ba>^c�Due s .�c' � <br /> R"r.�(1a"�jr��� a�a a—�OG�'� .S}-SE E�;o�n t� 9�z��e� 3 a�-��� � <br /> Owner Mailing Address City Zip Phnne <br /> S Gt l�i� <br /> Applican� Mailing Addresa City Zip Phone � <br /> Describe Proposed Work j�� S_�`��,(q,� �V `"�]/�'P�(' -� LnT 3 � L�iA IPv� �� i�C � <br /> Prolecl Address(if known) �Q8�7— ��*h v� ..�� � <br /> � <br /> Attach four(4) copies ol plans lor proposed work- Draw�o scale and note the tollowing as applicable: n� <br /> • Property Lines • Centeiline of stree� /w <br /> • Outline and dimensions ot ali existing and i Indicate North V� <br /> proposed siructures on the lot r Sho�v any proposed gradir� changes <br /> • Existing and proposed u�ilities ! Show measurements � <br /> �'� DO NOT WRITE BELOW THI;i LINE <br /> PEFMI7CONDITIONS ������ � — � <br /> t.�II calls lor inspection shall be made 24 hrs.in advance-phone 259•881 Q � <br /> 2.All work shall be peAormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards antl SnBcifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800^424•5555. � <br /> hll' Ct l(1NGE IIV. TI-IC: L�I.] ��EWAY CUf h1U.� l" Is� , ,� ! �!::ll�vl D <br /> i i' THE i 'UDLIC ldOf�f � 71 !-il''[CTOR. � <br /> � US[ �IJL•L.IC Ui�RTNqLF SY5TFM A;S Ff�OVTDED tO�i 1 'll-�. U-�! '� � ' f'" <br /> _ <br /> i . �-,ldY LnT r��Ul: CHANGES NILIST RE f-1F'F'ROVED L-�Y l'I IL ■ <br /> I-UBI_ [L; WUh'f'S TDISf-GCTOF.. r <br /> 1'tF..F' C1TY ,�,"(hFE7S C�C�N AT AI_L 1"Ih1ES. �p <br /> iNSTAI L Wf�T�F EOXF , 'TO _r,f�f1DE AT TI.,F EPI� OF r � , : ,".i�: . _OFI �d <br /> ryf1f;E ll�'E: 1 [ C:11JP� � ' '�� �- '1I�11 'LF �cl_`i CI. [ I ';,r_i . � � <br /> il'. ! ': IIU �..ii-�; , � i� � ' <br /> � <br /> ACKNOWL[DGE�4ENT OF CONDITIONS <br /> The undcrsr�ned owner/applicant!iereby agrees to hold and save harm- <br /> less the Gty of Everett Irom any and all claims for damages, costs. <br /> - expenses. or causes of action that may arise because of installation <br /> � �i'., i � and maintenancc of the improvement or o�hei right-o�-way use hereto <br /> � i'��i.:��v i CO �' ' J��'�" ,J�i3 <br /> applied lor and further agrees lo remove sarze upon notice Irom the <br /> Apr.roved loc Construction Da�e City and to replace pu lic properry damaged thereby. <br /> pi C� <br /> � � l �� /�� ,���� � r <br /> �•� � �% �" '1 (i�p <br /> INAL INSPECTI N i� Dele �O� - ��y/yyti 7���J G <br /> Approved as Covstructed Sig ture of Applicant Dalc• <br /> evrrett PUBUCWORKSDEPARTMENT N�ORK AUTHORIZGD BY THIS PERMIT MUST 8E SiAFTED WITHIN <br /> � 3200Ced•rStree� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6G <br /> Phone�.259�t3810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />