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I <br /> Da te_4, _� 8 a��oec wn.xa c»m�n. ,�9—/.3 J <br /> Applicahon For ein9 000i.. 3,i — i=?d;,� <br /> PU �3�.iC WORKS PERMiT � P��" � <br /> Pubbe Ylores Fe9 <br /> Toial Frzp S <br /> ld5SA00L i'eB Pdid S <br /> Print or Type pnly s��,��eo�a s .xG� <br /> ��7?.�, . �' � „ r ,� � ='� <br /> '�=— : i� .,n C/�— � � ' f' O�� <br /> � . _ c.:"�,._'.'�.�.."2 ' � / ? i_ 4,<r �? <br /> Owner Mailing Adtlress C�ty Zip Phone <br /> ��-�l+�F <br /> Apalicant Mailing Address City Zip Phone <br /> Desrri6e Proposed Work ` �c' _ — � _ - •'i '�-� i'�'i-�� <br /> �� <br /> Projed Adtlress(it known) � � �:—' ^ Y� .G:r� !'` � <br /> Attach four(4) copies of plans for prcposed work• Draw to scale and note the lollowing as applicable: � <br /> • Propertv Lines O Centerline ol street � <br /> O Outlinz'and dimensions of all existing and • Indicale North <br /> Proposed stiuctures on ihe bt • Show any pr000sed grading changes <br /> O Existing and proposed utilities • Show measurements <br /> DO fJOT WRITE BEI.ON' THIS LWE /�� <br /> PERMITCONDITIONS l y <br /> 1.All calls for inspection shall be made 24 hrs.in ativance-phone 259�881 O. �r' <br /> 2.All work shall be performed in accordance with this permit and current City of Evorett Design and Construction � <br /> Standartls and Specifications. <br /> 3.Call Location Untler9round Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•555$. <br /> q . :�; ��_' CH�IV.r,r- IIV THE Dh:I�:�=;�IraY CUT l�UST GE AF��ROV�C� � <br /> �'; Ti-IE F'UFiL�C 4dORt':S IN�:F'EC?OF. � <br /> S. UgF �=�uL,i_rr urr,rPIAUE SYS'TEI`1 AS PRU`JT�Fr� �C1R D��WIVF^fJ�ITS. <br /> �. (1i`•!Y I._OT GRAD� ri-{qnlG[S MUST BE AF'FR�IVFD BY THF_ <br /> 1='U�.i_:C 'dORI':^ IINSF�CTOi=�'. � <br /> � I t C'=' I.IT i .::i i I�C�T� I;�GAfJ r-i i ALL. l h9E . <br /> ' IN�'TyL� WI,T �. ,:C .c^ TO r� rr,i .;T T�-+F �=�,n n� rni�i..,r;-�irTrn�,� s � <br /> �- MFiL..c �� n� I'.'��JAti'S ARC ("'.1 -p. � - <br /> J� 'T'-I `( . t_F1=I: GF'=OrnF �� � <br /> ��i�._vr ir� �v,,.� rF�ir_ii. V � <br /> � I <br /> � <br /> � <br /> I <br /> ACf(NOV✓LEDGE��IENT OF CONDITIONS I <br /> The undersigned ownedapplicant hereby aqrees to hold and save harm- � <br /> / less the Ciry of Everett from any and all claims for tlamages. costs. <br /> ,/ /'+ /, � , expenses, or causes ol action that nay anse because of installation <br /> /,���� /'y��.�_-- �,/���7 T and mamtenance of the improvement or other riyht�of-way use hereto <br /> Approve�tl el�oI/r ConatrucCI�on (r -� �' Date applied for and fur�her agrees to remove same upon no'ice Irom ihe <br /> ��j�wW+ �� �LG'�I ✓���il�� �f1jL31L'{R �{(L( City and to replaCe public property damaged Ihereby. <br /> � � , � y/�/�-� <br /> c. d •�_,LGi,�/ ,f'�— <br /> FINAL INSPECTIO p��� <br /> Approved as Constructetl Signalure of Applicant �� <br /> evrret[ PUBLIC WORKS DEPPRTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STAR7ED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND iHEREAFTER IS TO <br /> Everett,WA 98201 BE DiLIGENTLY PURSUED TO COMPLETIOiJ. 7HIS PF_RMIT MAY BE <br /> Phone:259�8810 CAN:;ELLED BY THE CITY UPON ANY STOPPAGE OF�NORK ON THIS <br /> I PRGJECT OVER 90 DAYS DURATION. <br />