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I <br /> I <br /> � 'r: <br /> e.I�yl. <br />� � ..... . . . . � . ��:... . ..�. ' � l � �� <br /> � : <br /> ,1 !� / , Q � : <br /> p�;iQ �✓�V I PWhcV:orksPormpll•/ `D1__�_ ,',_';� <br /> Application For <br /> BitlB.OeCI.a /f Yl� 7 .J�l � ' ��"�. <br /> PUSLlC i+"VORKS PERIV� I�" �°�,o���oF�° � I .4� <br /> Less Appl Fee Pai� S_ " <br /> C70 <br /> Print or Type Only oa�.,�<oo�� s ��— _ <br /> _ � � �,�j1,4' �(7 V1 N e rc ��(c�,'—1�J l'r V i P,-- .��r'I %�-�G`/ � S 3— /���,�1 _ <br /> Owner � Mailing Address ' CiIY Zip Phone � <br /> � � <br /> �fr�.+.—�-...a.��1.�-� ' �E ��b�e i �,�/ !��� 9�':�a� . i ` <br /> � in rrT o 7/_� /0/� � � � <br /> Applicant Mailing Address Cily Zip Phone I. - <br /> / � i 4'. <br /> Describe Pwpo;;ed N/ark ��i P UJ Si�-��a/N ��(Y GU��- P � � � � L a r ?�� f��/��, ��i/1CI� '�S � � <br /> Project Address(if known) �g��— �� � '�'E- -s� � . <br /> _ � <br /> Attach tour(4) copies ot plans for proVosed vrork- Draw to scale and note the tollowing as applicable: _ <br /> • Property Lines s CeNzrline ot street f� <br /> • 7utline and dimensions of all exisiing and • Indicate IJorth �� <br /> propo5ed structures on the lot e Chow any proposed grading changes <br /> • Existing and proposed utilities • Shoci measurements u <br /> iiY <br /> DO NOT WRITE BELOW THIS LINE <br /> PERIJIT CONDITIONS � <br /> 1. All calls lor inspection shall be made 2A nrs. in advance- phone 259•881 5. � <br /> 2. All wcrk shall be perfo�med in accordance with this permit and current City of Everett De�i9n and Construction <br /> Standards and Speci(ications <br /> 3. Call Location Underground Service 48 hrs. be(ore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> j . T�Nf� �:�J;.--/9C�" c.L.,-v3 Le' C.-L i _� . ' �/ <br /> / i GlFlir�f�i.-C ) b,// <br /> ,%�� , � '. <_,:,�ij .S'.v'�= O'� ,.� f'_. �$�c �7 ,�>�/ %ii-. 'r'.✓�^�:J? <br /> � <br /> � <br /> � <br /> � <br /> ACI�NOWL[DGEPdFN i OF CONDITIONS <br /> Tho undersyned owner/appLcanl hereby a9rees to hold and save harnr <br /> --I Icss th� City ol Everett irom any and ell claims for damages. cos�s, <br /> -- - expenses, or causes of action that may arise because of installation <br /> /���'�� �-���� /G,-, `� � ;`g� and maintenance of Ihe improvement or other right-of-way use hereto <br /> applied for and (ur�her agrees �o remove same upon notice from ihe <br /> Ap ed for Consiry� io . Da�e Cily and to replace public property damaged thereby. <br /> �tX.N � v�'� ��_., /J � .�i <br /> FINAL INSPECTION Date (/ / +�r, / /�} -��y �G <br /> Approved as Constructed Si ature of Appllcant ' Date <br /> everett PUBLIC N�ORKS DEPP.RTMENT WORK AUTHORIZEDLBY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PEfiMIT IS ISSUED AND THEREAFTER IS '�r1 <br /> Everett,VJA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY Bf <br /> Fhone: 259�8875 CANCELLED 8Y THE C��TY UPON ANY STOPPAGe OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />