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Date l( !�.� -�,� ���,h���w�,�.,v�„„�� —,�(�s�'�_— <br /> Applir.ation For ein�.ocn��+ ��7��J ��7- <br /> PUBLIC WOR�K� PERI�I �T Nu'vbcWorksFoa <br /> TolalFve $ <br /> Less Appl.Feo PaiO $ <br /> Baiance Due �u� <br /> Print or Type Only <br /> � C� �PNC�iAC�r(',u Ci,. III SP ��J�� �'�II ��2�/ E✓P.L����C� L��� <br /> Owner p4ailing Address City Zip Phone <br /> �(�� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Pro�osed Work �P_rA/ .��� �'T cJ� �t'$j��i �O/' <br /> ) <br /> - � <br /> Pwlect Addre�s(if known) . ���2� - �/���,'_ L_�r.s'. � � <br /> Attach four(4) r.opies of plans for proposed work- Draw to scale and note the (ollowina as applicable: o� <br /> • Property Lines • Centerline of slreet /w <br /> e Outline and dimensions of all existing and • Indicate North �, <br /> proposed atructures on the lot o Show any proposea gradine� changes <br /> O Exis�ing and pwposed u�ilities i Show measurements � <br /> DO NOT WRITE 9ELOW THIS LINE <br /> FERMIT CONDITIO'd5 � <br /> 1. All calls`or inspection shall Le made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance wi;h this permit and currenl City of Everell Design ond Cons�ruction <br /> Staoda�ds and Spe��.i��'ic25ons. <br /> 3 Call Locat on Ui�deigr?�.:r�� Service 48 hrs. before you dig.TOLL PREE NUMBER 1-800•424-5555. � ' <br /> i <br /> � , � li . � . �. . , . , � <br /> - . F'Ut'i_ i � LiiiFi� i,Ur:. .� � i ii_I°I (` �. � � � �' <br /> l <br /> �_�ir cr,anF- ca-i�i�i�r_:; ��_r;T E;i �.� F r �, ; <br /> tfl..iC: bJfJl��'�i IN'-;FF_.Gl"Of- . - _\ ' <br /> I CI1"� , IF.Fr � � CLrAN F`7 o?I L 'I'TP�: <br /> \� <br /> � � inLL �,JAI r.:�i � r, r � � <br /> �,': I <br /> _.� <br /> ACtcNUWLEDGE1v1ENT OF CONDITIONS <br /> Th�,undersigned owneriapplicaN hereby agrees to hold 2nA save harm- <br /> - Icsc ihe City of Everett irom any and all clairns for damages, costs. <br /> �/ / expenses, or causes of ar.tion that may arise because of installation <br /> �{�'�;�'/ /�X� / �`//p� ard maintenance of the improvemenl or other right-ol-way use nereto <br /> / Lu� l3- /-Z- i�' O applied for and furUier agrees to remove same upon notice from tr�e <br /> Approved for�Gonstrucfion Date � y n to re lace public prop�erty damaged thereby. <br /> o �, i <br /> ; � / r�`�/'; /1� ,�`t t i ^ <br /> / ` f- ,. .� - — /�� - �c <br /> FI ALINSPECTION' � Date � 3'-2��^�O <br /> Approved as Constructed Sig ature of Applicant Date <br /> Ieveretl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> A 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � Everett, WA 98201 f3E DILIGEMTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPHGE OF WORK ON THIS <br /> PROJ[C�l�OVGR 90 DAYS DURATIOfJ. <br />