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Date_L��`5� a������o,RSP<<m�����c�i�`� 7�'2 <br /> Applicafion For em❑.o��i,+ ���—_ <br /> PUBLIC WOF�F�S f�E�MIT -`��`� <br /> Punl¢Worhs Fec <br /> Total iee S <br /> Le55Appl FcePal� �u C�`' � <br /> ealanceDue $ �V—"" �� <br /> Print or Type Only -- ' <br /> . <br /> � �=��� l�'F 1.���� CT� � 7 r l. ��- �� 'Y �'o�j-�C� <br /> Owr( r Mailing Address Cd� Phone <br /> Applicant Mailinq Adciress CitV Zip Phone <br /> Describe Proposed Work �� �1� ) � � (� ( �-lf �� I�,{ �_ _ <br /> — � <br /> q a �� <br /> Proled Address(if known) ��/�/ '" �d t,� ��y�E_ � <br /> AL'ach four I4� copies of Ulans for proposed work- Draw to scale and note Ihe following as applir,able: � <br /> r Property Lines • CeMerline of street � <br /> C Outline and dimensions ot all existing and O Indicate Nor�h <br /> proposea structures on tl��e lot O Show 2ny proposed gradin9 changes <br /> • Existing and proposed utilities Y Show measurements � <br /> DO NOT WpITE BELOW THIS LINE <br /> PERMIT CONDITiONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> ?.All work shall be periormed in accordanca with ihis permit and current Ciry o(Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ;}. A���1' CF;r-illui_: t:W "fliE Df;r�.�E,.�.��r� � c.�.rr hili� i EF fll='Pi`iC1vEi) <br /> Er! "fFIE f .JI=iI..SC L1�F�::S Ihl i�'FC1 UR. � <br /> `S. USG F'UI�L?C llf,AIN(1CiE ;YS �Eh1 (1S �ROVIDFD FOFi );D��tl;'F'(7Ui; . <br /> %, .ilf�lY L07 GFi(1DE rHANGt�u h1U3'f BE nr-r-�ovr_-r, f3Y 711i=[ <br /> F'UY".LIC PJOhk;S IPdSF'ECfOR. � <br /> '.KEEP CITY STR'r-F_'fS CLE(-1N nr (�I_L 'rII9ES. ! <br /> _:. IhISI'Fll_i_ W(i'fER BOXEB TQ 6FCiDF A7 THE FI�! � � <br /> D OF CO��J" I RUC7IC�1�I � <br /> ;.t7Pif L Eil��l DRI VF"40A`(S (1RE C�]Y1F"I_ETELY �'UFEi7 E�EFOfJ � ; <br /> �el IV�IC�!G OtQ Tr'�t1 ' <br /> �i� nllp �:( I � ( f.. "f�l filE �iq �: 11Pj�, � i I-_'� il �!TI I RF FE( �l7i�tl=J"� � � <br /> I �` IIII ! 1"ft� in �.l� ; t.11l i � III i ��,�_� ' i� '-f .�_; LI F'T. <br /> fCKNOWLEDGEMENT OF CONDITIONS <br /> __ 7he und��rs6_�ned owner/applican�hereUy agrees to hold and save harm- <br /> fes, the GIy of Eve�ett from any and all claims for dam�ges, costs. <br /> �� ,---��� expenses. or causes of action that miy arise because of installation <br /> L— ���b.`�� � and maintenance ol the improvement or o�her right�of-way use hereto <br /> Approved lo.C�onstrucli ,� Date applied for and furiher agrees lo remove saine upon notice Irom ihe <br /> : � , City and to replace pi�blic property damaged ihereby. <br /> ��� �/ '�S. ` c%l�/, �// �� // ' ' / b(� <br /> FINAL INSPECTION` •' " � �—Dat�� \l/ 1/.� �� �� � -2t��r,i/L" Q �'/�i /if /f <br /> Approvetl as Consiruc�ed iynature ol Applican�� —��� <br /> everett PUBLIC WGRKSDEPARTMENT WORK AUTHORIZC-D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CeAarStreet 180 DAYS OF DATE PERM1-IIT IS ISSUED AND THEREnFTER IS TO <br /> Everett,WA98207 BE DP_IGENTLY PURSUED TO COMPLETION. THIS PEFiMIT MAY B[ <br /> Phono:25&6�10 CANCELLFD BY THE CITY UPOIJ ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 9n ���YS D;IRATION. <br />