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-. <br /> C^�/y'1 , yI�. -- <br /> Date�(_� � Public Works mu. S.����' <br /> • � , <br /> �4pP��cation f x eiaa.oeo: ^ �_ <br /> PI�BL.I�' 1l'��9�K� PERMIT PueTolaFeeF�� g --� <br /> LessAOP�Feo Paia $ <br /> eaiance Duo S =71f�p� <br /> Frint or Type Jnly " — <br /> � � <br /> fj8 9�G <br /> ��,� ����r�� � � �.3//� - Il3`` l� s�� .,���r� �s3 - a3�� <br /> OWner Mailing Address City Zip Phone <br /> �l ha E _ <br /> Applicant Mailing.hddress City Zio Phone <br /> Describe Proposed Work — �'t U �L./_�)C <br /> Project Address(if kncwn) 29C�S— ��� — %C7'—I-�_�7�=� � <br /> Attach four(4)copies of Qlans for propused work- Draw to scale and note the following as applicable: � <br /> O Property Lines • Centerline cl sireet /A <br /> • Outfne and dimensions of all existiny and e Indicate North �, <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measuremen�s � <br /> DO NOT WRITr BELOW THIS LIhE � <br /> PERMITCONDITIOVS <br /> t. All calls for inspection shall be made 24 hrs. in advarce- phone 259•881 5. � <br /> 2. All work shalt be perfo•med in accordance��ith this permit and current L;ty of Everett Design and Constructicn <br /> Standards and Specifications. <br /> 3. Call Localion Underground Service 48 hrs. before you di5.TOLL FREE NUMBER 1-80�•424•5555. � <br /> �-f, /O /�f CG2'ST.�UC��/� p« �'EI/iS�-�,7 -Si TL O <br /> `'�Q/'✓ .S'Gi�.r,�iii�O J�-/%'.5'S <br /> � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applirant hereby agrees to holti and save harm- <br /> — less Ihe City ol Everett from any and all claims for damayes, costs, <br /> expenses, or causes of actio., �t may arise because of installation <br /> ���2� �/�� �s.- and maintenance of the impro�ement or other righbol-way use hereto <br /> � �"� applied for and further agrees to remove same upon notice from the <br /> Approved for Constr ction Date City and to rep)ace public property damaged iher?by. <br /> �;-����� �i.�"�� � ' <br /> «.�. ���/s� <br /> FINAL INSPECTION Date . <br /> Approved as Constructed i atur pplican � Date <br /> everett Pl�9LIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1&0 DAYS OF DATE PERMIT IS ISSUED APJD THEREAFTER IS TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA' DE <br /> Phone: 259-8815 CANCELLF D BY THE CITY UPON ANY STOPPAGE OF WORK ON 1H15 <br /> PROJECT NER 90 DAYS DURATION. <br /> ■ <br />