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iolsa , ; <br /> � � ..:"� � ... I i'ublic Wo�'.s Verm�l�' —_— � '-- <br /> Date � , ! � �.4�.�;� <br /> E��a�,.oao��+--- <br /> Application For <br /> 11 ��I_IC V'�ORICS PERMII� � PUO�oaIF�eFee s _ <br /> l�es I ipl.Fee PaiE S -- �� <br /> 0..�ancr Dve��"� � <br /> Print or Type Only � f�EE�E�h�:r <br /> ��7��3ZZ <br /> Joim B• Schac,: 1�24 t9est h!urir.e �"ie•d llzi��e Lverett 9f3:7i 339-2500 <br /> pW�e/ MailingAddress Ciry 7_ip Phooe <br /> Nor� Andexson P.o. ro:: r'�r.' '.ta•::.sn'i1L= ^E?2' 0 655-1131 <br /> Applicant Mailing Address City Z�P Ph��e �. <br /> i <br /> F,.dcil.ti.on to -�xicti.itg :st;ilc`�n;t :" � <br /> Deacribe Proposed Work — — -� <br /> _— � <br /> --p�r.w.a�l <br /> J <br /> — — � 1 <br /> ProjectAddress�if known) .1023 '�ieet Marine Ciew Dzive ____ _, �yr j <br /> Attach four(4!copies of plans fcr proposed work- Draw to scale and note the tollowmg as applicable: �� I <br /> • Properry Lines • Cemerline ot street �A • <br /> • Outline and dimensions of all existing and • Indicate North V Ir �� <br /> propo�ed structures on the lot • Show any proposed gratling chanr_�� i <br /> • Existing and proposed utilities • Show measurement; � � <br /> Y'.� � <br /> DO NOT WRITE BELOW THIS LINF � � <br /> PERMIT CONDITIONS I <br /> � ' <br /> t. All calls for inspection shall be made 24 hrs. in advanoe- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and curront City ot Everett Design and Curstruotion <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. bebre you aig.70L1 PREE NUMBER 1•S00•424•5555. � ' <br /> 3! c� �3_- �o,vs>�<ucrFD ,as Pr,� f=�%ti� � �"01 <br /> v <br /> .c�f�r�.r c'Jl.�CL� F'2%� !�d TrC' /.'7/��c / cQf< <br /> � <br /> , � � <br /> O <br /> � <br /> I <br /> � ACKNOWLcC'GEMENT OF CONDITIONS <br /> The undersipn_d owner/appiicant herr.by agrees to hold and;ave harm� <br /> � less tha City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of aCtion thal may anse because of installation <br /> I � * �� .� and maintenance of �I�e improvement nr other riyht-oFway use hereto <br /> � �-- �� ��'::"'_�����7---- �����G�'� s'`" applied tor and further ac�rees lo remove same upon notice Irom lhe <br /> _� ,�. <br /> Approved fo(Construction � /ba�e CityJ�a nb to replace pub�ic roper�8amaged thereby. / <br /> � �'0�.... �5- U.' � � --�'� � ��`.E,1lL- <br /> ` ,,,, <br /> 1iFINAL INSPECTION Date � ��—)�.��%�/ .�'. � ., '.!-v � ,�� C..� , <br /> Approved as Conslructed Signat re of Applicant Dale <br /> WORK AUTHORIZED BY THIS PERNIT MUST ��E STARTED WITFIIN <br /> � everett PUBLIC WORKS DEPARTMENT 1&J DAYS OF DATE PERtd1T IS ISSUED AND THEREAFTER IS TO � <br /> � 3200 Cedar Street I 9E DILIGENTLY PURSUED TO COMPLETION.ThiIS PERMIT MAY BE <br /> Everett,WA 98201 �AN�ELLED BY THE CITY UPON ANY STOPPF.GE OF WOHK ON THIS <br /> Phone: 259-8815 pRO.IECT OVER 50 DAYS DURATION. <br /> I <br />