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-� <br /> 7 + <br />�.,. �` ����'� <br /> I ,� <br /> ',r�I <br />, I i <br /> 1 <br /> r' � � <br /> Date '"� � � � � ��' ' "' �� 8�—.j�� � � ����;k� <br /> -� � ` Pu01ic Warks Pcrm L <br /> Ap�!ication For ` � I eiau o�a�.e � � . <br /> PlJBLICWG'�RKS PER'\)'�T Pu�6cWorksFee -- <br /> � •e1• � iotalFee 5 <br /> 1 <br /> �\ Lass Appl Fee Va�d �u <br /> Print or Type Only � 8,�,�=�o�e s 20— �— <br /> ! � rl <br /> '� (�rl�t� '�'[ �P�.I � ��YYt�JI'K.0 <br /> wner Mailinq Address Ciry Zip ' Phone <br /> �����- <br /> Applicart MailingAddress City Zip Phone <br /> Uescribe Prop�sed Work �4_`` I .� I ��( iV C '1 ',� 1�a �[� <br /> Project Fddress(if known) ��/ Z 0— ��t�vi(� S�, � <br /> F�tach fow(4! copi2s of plans for proposed work- Draw to scale ar�d ,�ute IPe following as applicable: � <br /> • Propzrty Lines O Centerline el 5tree� � <br /> i Outline and dimensions of all existing and O Indiw�e IJoCh <br /> proposed strucWres on ihe lot � Show any prop��sed grading changes <br /> • Exlsting ar.d proposed utilities • Show measurements <br /> v�s � � <br /> DO NOT WRITE �ELOW THIS LINE <br /> PERMIT COND..�IONS o <br /> 1.All calls fcr inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with ihis Permit and currcn[City oi Ev�rett Design and Construction <br /> Standards and Specificaiions. j <br /> 3.Call Location Underground Service 48 hrs.before you dig TOLL FREE NUMBER 1-$00•424•5555. <br /> � <br /> , :r�Nv �:ri,anirF= rN �ria� n�,���v.r-.�dnv r_•i.�r r•r�,-r �,e: n.�r-���:n�,�.�, �. <br /> ,, I_+v -riit_ F�urii._r.c t��n�fcs I��lSPf:CTQF , �� I <br /> J'�F F'UHI_IC DREI[IVALiE il`.i"fF."11 AF; F'Fi0!J7D�Ii F0(z: DO�,dil`?^�IUT^ . <br /> � , AIVY LOT G�:AI.�E CIiAN[[�ES t'ILI�T Rlr: (1F'FI�OV[=I� BY T�-IE � <br /> ; i.if+t rr., idC ("�� i IN�'i �.r,l'�f;. <br /> � EF cin � rrr�r� r,i_��nn� nT ni.i_ Tirif.s. ♦� <br /> . i � i�rni_.i.. �dr i r.-.r, F�o�; , rn r,�:nnE rar� ri,r_ r_rin ae- r;a�i�, i � ��- �� �,, v/� <br /> �I��'.i. SUhE DRTVE4�!AYr; (1RE L:(JhIF'I_ETF.LI' CliFt?J? E�GFnF�r � , <br /> ��� r � u�a� ou iftr.=ri <br /> � � u - n���r�nr��- -rn r; � ct��r-� nr�n � n�lint � uri_i � i_ i��� � ,�i,,�-,� � � <br /> 1 IHP. � ��l T<�i ! I I Illj�.l �l.- -1�IIF� ('i1�I..Ti I Ifl 'i��'. I � � <br /> ACI<NOWL[DGEMENT Or' CONDITIONS I <br /> The underslGned omner/appGcant hereby ag�ees to hold and sava harm- <br /> v less �he City of Everett Irom eny and all claims lor damages. costs. <br /> �r�� �.���� f�JO7J-//�'' �6' expenses. or causes ot ac�ion Ihal maY arise because of installa�i��n . <br /> and maintenance of the improvement or other ri9ht-of-a�ay use hereto <br /> applled lor and fwther a9rees to remove same upon noiicr !rom tl+: <br /> pproved tor Constructi n Dale <br /> Cily and �o replace pu6lic proPerty damaged ther�ahy. <br /> FINAL INSPECTION Date <br /> Approaed as Construded Signature ol Applican� p;��� <br /> everel[ PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY �iH15 PERMIT IdUST BE STARTED W17HIN <br /> � 3200Cedar.treet 7B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Phonc:25&F3910 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />