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�.� _ __ _ __ . <br /> = <br /> k`:- -� <br />��, �� � � `�'��� <br /> i` <br />!; � <br />` � <br />, <br />" � <br /> �, <br /> � <br /> oate'� i' �` � <br /> ' _�).i_6 P�e���wo,�3P�,m� . <br /> � <br /> Applica;ion For 01tlp o`P�.` � � j <br /> PU��31.1� WORK� P�RM13 P°„�.�Wa,ksF�� — ; <br /> ra�,,�F�� s I I <br /> �essara� PeeaaidS I' I <br /> Print or Type Only oo�.,���oo�a s � <br /> `�'JY��? . �'Q`� . �(� '���� .:����;i if'X" �1l r,�'�� ��aC� � �7q-�?�� � ��I <br /> Ownnr Mai�inghCdress Ciry Zip Phone � <br /> �1�— <br /> Applicant Mailing qdd�ess Gty Zip phone <br /> �escribe ProGosed Wo"c . �I lo��l '��( 1�)� I� ���,.______ .. .__ �I, <br /> — - �.�.�� II <br /> Project Address(if known) - � � <br /> Altach four(4� conies of plans for proposed wod�- Drew to scale and note the follo�ving as applicaMe: � <br /> O Property Lines • Centerline of street � <br /> • Outline and dimensions oi all existing and • Indicaie IJorth <br /> proposed structures on the lot • Show any proposed c�rading chanyes <br /> w Existing and proposed utilities • Show measuremeNs � <br /> w� DO NOT 1NRITE BELOW Th11S LINE <br /> PERMIT CONDITIONS � <br /> 1.All calis for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance viith this permit and current City ol Evereu Gecign and Construction <br /> Standards and Soecificalions. <br /> 3.Call Location Underground Service 48 hrs.bufore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> /(/DT ��di�6'"O ���As � <br /> `� � <br /> � <br /> � <br /> t�°" <br /> ACKNON'LEDGEMENT OF CONDITIONS <br /> The undersiyned owner,�applic�nt hereby ac�rees to hold and save hann- <br /> less the City of Everett from any and all claims for damages, cosls, <br /> expenses, or causes of action that may arise bec�use of inslaltation <br /> and maintenance of the improvemenl or other nqhPol-�vay use hcmtu <br /> applied for and furiher agrees to remove same upon noticc Iroin tl��� <br /> Approved tor ConsUuction Dale City and to �eplace public property damac�ed thereby <br /> FINAL INSPECTION Date <br /> Aoproved as Constructed SiynaWre of Applir,ant Date <br /> everMt PUBUCWORKSDEPARTMENT WORK AUTHORIZ[D BY THIS PEAMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND Th{EREAFTER IS TO <br /> Evere��,WA98201 3[ DILIGENTLY PURSUED TO C0��4RLFTION. THIS PER�a11T I.fAY �E <br /> Phona 259-8810 CANGELLEC BY THE CITY UPON ANY STO�Pi�GF_ OF\VORt< ON 76115 <br /> PROJECT OVER 90 DAYS DURATIO�I <br />