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. sr�r�� . �0+��!0 —� <br /> Date� � U� <br /> 1 P�,������,�,��N,.,,,�� o �� —.�. <br /> � <br /> ���pPlication For dir.� neP�., ��' -- ���t�. <br /> i�I�BLIC WQRKS PE�MIT I YU1iotalFe�Fcc S --- <br /> Less FPPI.FeP Paltl S— <br /> Print or Type Only e��:����o�P s ��_ G-�— <br /> I <br /> �Ll� '� � �.—L�� (n�-cV7 �L- ,��,F��I���,��, �; c;;�= . <br /> Ownet� Mailing A dress City ��� Zip Phone <br /> UC c�� cJG{ ,( 1 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Worl� Y �'�Q �1�p ��1`�� � ' � ��7f'� r��'��k <br /> � <br /> ��� <br /> Project Address(if kno��m) ��//.3 — �[7� f�� �'C � <br /> Atlach lour(4) copies of plans for proposed work- Draw to sr,ale and note the (ollowinq as applicabla: � <br /> • Proper�y Lines • Centeriine of sireet ,/A <br /> • Outline and dimr.nsions of all existing and • Inaicate Nath �� <br /> proposed structures ori the lot 9 Show any proposed grading chan�7es <br /> • Existing and p�opose•i W:Gties O Show measurements � <br /> � <br /> DO NOT WRIT[ BELOW THIS LINE <br /> P[RMITCONU!TIONS � �., <br /> 1.All cails for inspecl'on stall be made 24 hn,�n adva�ce-phone 259•8810. �.� � <br /> 2.All work shall be perlormed;n accordance�.vilh thi,permit and current City o(Evzrett Design and Construction „� <br /> Standards and SpecificaUo-c;. " <br /> 3.Call Localion Undergipund Service 49 hr;.before y;u dig.TOLL FREE NUMBER'I•800-424-5555. � <br /> 4,F11�!Y ChIAt�16F Itd THP' DftfVE:Jr-�' CUT I•1UST L;� AF'FROVED <br /> EtY THE PUBLTC 4dORt::B lNSPE.;�TOk. p� . <br /> S,U�[E FUL'.LIC nr,nrnin�i_ �,YB'fFl°I FlS PROVTDFD FOR DOb!i,IiGi 'ii! if'' . ��� <br /> �,/1��IY I_OT GRADE r�-��PlGES MUST F+E AF'F'ROVED BY THE <br /> i'UE�LIC blORk;S INSPECTOfi. � <br /> 7,K:E[:F' CITY �"fFEF'I'8 CL_EI1N AT �LL l'IME:S. <br /> i'. INSTALL. WA I k=f=� I_tp,v,F.�; TO G�;A17E AT l-f-IF_ END OF C01�!iJ';'r;U('l"f�_II I ♦� <br /> '; .t1Ak:f-_ SUF2F DFiIVF:I,�;;y�i Ai�E COr9Fi LT�LY CUREU F:EF�J;tE ��� <br /> liR(�IIN(� ON ThlEt�i. � <br /> � iilJl' ililhl{1C�F TO THc C'URCi nrdn SIDEId(1Lf:: WILL FtE � I � ,`� II:F!� <br /> Tp T�ir ^r'iT:[`>i !'ir:�7-T�rl OF 1�IIG F'IJF?I lr 1qOFJ _ i)1=FT . � <br /> .'�CKNOWLFDGG�,I�NT Of CONDI i IONS <br /> �__ Thu undersic7netl ou.neUapplir.anl hirrobY 2grees te huld�and snve harnr �. <br /> less the Cily of Everett irom sny and all claims im damac�es costs, <br /> . _ /� / � I expenses. or causes of ac!ion Ihat may arise hecause of installatio�i <br /> ��/��,�� G U�� and maintenance ol �he improvement or other right-ot�way use hereto <br /> Approved f r Consiruc�ion � applied for and lurther ac�recs to remove same upon notice Irom the <br /> Date City and to replace puUlic property damaged �hereby. <br /> � i <br /> �� ��6��� � � <br /> > > ,_�- , <br /> FIMAL IN EC N �� Il� �t�.. ,�-�.-� ' � �i-� � - � ��/� <br /> Approved as Consiruc�ed Date �,��' % �` � G'�� i i <br /> �Stgdature of Applicant Dat <br /> everett PU�LICWORKSDEPARTMENT WOFK AUTHORIZ[D BY THIS PE9MIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND TI'C9EAFTER IS TO <br /> Eve�ett,WA98201 BE �ILIGENTLY PURSUED TO COMPLETION. THIS I�ERMIT MAY p[ <br /> Phone:2.59�88t0 CANGELLED BY THE GTY UPON ANY STO°PAGE OF WORK ON THIS <br /> PROJE;T OVER 90 DAYS DUR�TION. <br />