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( <br /> � <br /> �-<.'-_" q y,"� <br /> Date I I "_, ,�,�., r���,�,-o-��,k�r����,,,�1 �" ..y-_ <br /> Applir.ation For B1°�.°e'P' • �'�� � `� / " _ <br /> PIJBLI� VIIQRKS PERMI'� P����W�.����F�� �` ` � �- <br /> TOIN Fco s <br /> Le:s ApP��Fee Pmd 5 <br /> Print or Type Only "�""Ceo°°_ <br /> 5 Z�—�— <br /> _, � _i . � � _ .i � � ,t—� >>_'.., '� � C�_ '7 . c^ � C �.. �, � . <br /> , , �� �� � � i , � � � � � t �l f�� L� :>��'� �1'1 � T�,�L�5 C�> >.� <�;>: , <br /> ' � Owner Mading Address City Zip Phone � <br /> -� ���,�'���� <br /> Applicant Mailing Addrass City Zip Phone <br /> .�- � <br /> ' < <�t V �-��'M`1 ��(-�l <br /> Descrlbe Proposed Work c >��-- _ � _� ��� 1 <br /> P�oject Address(if knoem) /�/ /ZS — /Q — �,� s� � <br /> Atlach four(4) copies of plans br proposed work- Dra�v to scaie and note the following as applicable: � <br /> • Property Lines • CeNerline of street /w <br /> • Outiine and dimensions of all existin9 and • Indicate North V, <br />� proposed SIruC�ures on the lot • Sho�v any proposecl grading chan9es <br /> • Existinc� antl proposed utilities 4 Sl�ow measurements � <br /> DG NOT WRITE BELOW TH13 LIN� <br /> PERMIT CONDITIONS � <br /> t.All calls tor inspeclion shall be made 24 hrs.in advance-nhone 259•8810. � <br /> 2.All work shall be pedorr�ied in accorda.nce with this permit and current�ity of Everett Design and Construction <br /> Standards and SPecifications. 1 . <br /> 3.Call Location Untlerground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-$00-424•5555. � '�, <br /> � <br /> � '. <br /> � ' <br /> � <br /> � <br /> � , <br /> AGIWOWLLDGEMLNT OF CONDITIONS <br /> The undersiyned owneVapplican�hereby ayrecs to hold and save harnr <br /> less the City of Everett irom any �nd all claims lor dpimagcs, costs. <br /> D�" expenses. or causes ot ar.tion ihat may arise because of installalion <br /> �� ������— /� O/�7B and mainlenance of the improvement or other righFof�way use hereto <br /> �4f <br /> �� � OJ o rJ applied for and further agrees to remove same uUon notice from thc <br /> pproved lor Constr cti n , ate City and to replace puLlic property damaged thereby. <br /> •.�v,��.�a�fi �.�,1 n�,l �ti.c:�s�[wi.'y c��Y,<Lvc/ � n =r% <br /> � , �� - l{ryi,F'r /�eW:/.0 iL�i.[ / � - ��� � �, <br /> �INALINSPECTIO ��� Date �"� �� -�ll��"'� � �� <br /> Approved as Ccns!ructed Siynature of Applicant —L//�� Da�e <br /> tvcreU PUBLIC WORKS DEPARTMENT WORK AUTI-IORIZED BY THIS PERMIT MUST BE STARTFD WITHIK <br /> � 3200CedarSireet 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> Everetl,WA98207 B� DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259-�810 CANCELLtD BY TI�I_ CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ[CT ObFH 9p DqYS DURAiIOP�. <br /> � <br />