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i <br /> ; <br /> I,] � (��}' p ,/ <br /> Date1(�!J �_j50 �'��oecwo�ksr„yry.���iyo�- �C,��rr y <br /> F.PPlica�ian FGr eina ucci • _(�7��-4J-�1=1-/-(.-- <br /> r <br /> PUBLIC WORKS P�R�JIIT ����°°°��°«_�,.�------ - <br /> Tatal Fen g— . <br /> LessApal FerVanl S <br /> Print or Type Only ���,�=�.o,�� 5_ c'��-� <br /> �'a � ,`��1_�L��t � s !'�C>'�, NIl )����'IAX�- � �L�a4.�`'78C7�� , <br /> Ownr.r MaihngAndress City 7_ip Phone � <br /> .— C�/�ILIJ I <br /> Applicant Maiiing Address City Zip Phone � <br /> i <br /> '�1�- �J �n�L�''l�t 2':C�D l`',�� '� � <br /> Descnbe Proposed Work c _ <br /> I <br /> I <br /> .� W <br /> Projec� Address(il known) �70� - 5—AVE, �• � �i <br /> Attach four(�11 copies of plans for proposed work- Drew to scale and note the following as apphcable: � I <br /> • Propeity Lines • Cen�erline ol street � <br /> • Outline and dimensions ol all existing antl • Indica�e Norih , <br /> proposeU siructure5 on the lot • Show any proposed grading changes <br /> • Existiog and proposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS UflE O '�, <br /> PERMI�f CC•NDtTIONS <br /> 1.All ct.11s tor inspection shall be made 24 hrs.in advance� ,�hone 259•8810. � i <br /> 2.All work snal!be performed in accordance with ihis perinit and current City of Everett Design and Construciion <br /> Stantlards cmd Specifications. <br /> 3.Cal!Location Unde�yround Service 48 hrs.before you dig.TOLL FREE MUMBER 1-800•424•5555. � <br /> �'� ��f�iZc2''�'�� ��<.C-t'.cc�C..��.",/ /''�...� :i-�.t�� [jc[-7�':� .C'��i�!?-�E-Z�-L �i� O <br /> ?� v �i L. � [ /1 . _. <br /> �i,,, -�J i � -GC-'-ZLc."toq> J�1�i"ZOa-cfi. .S2tc,� 'CCc.,7 L2 -�. .. . �. <br /> i `/ / / � <br /> , /�LILc�L::�'�.fCCkf�C6e�d.tl7�l /.CZicf�. w I <br /> / .{� � f� ' _I <br /> 7 �"C �, / ,.�.� � . . . /��i � _ . . �'i . ( i � �� �/r"• , . qjfl � .� . -.C � � <br /> � . <br /> � <br /> ACKNOWLEDGGId[NT OF CONDI710N5 I <br /> Th��undersigned owner/applicant hereby agrees Io hold and save harm- ' <br /> -- Icss ihe Ciry ol Eve�ett Irom any and all claims for damages. cosls. I, <br /> expenses, or causes ol action that may arise because of installation ' <br /> � � �.�� ��, :. �_� � ��" e and malntenance ol Ihe miprovemenl or other riqht-of-way use heroto � <br /> J --F�� applied for and lurther agrees to remove same upon notice from the <br /> ApU�oved lo�Consiruct on Date Ciry and to rPplace publlc uroperty damaged Ihereby. �� <br /> j <br /> ' — ,�-r-�=s t� <br /> �. <br /> PiNAL INSPEC ON Date � � <�i/t / <br /> Approved as Constructed Siy�of�ipphcai� Date <br /> everetl PUBLICWORKSDEFARTMENT WORK AUTHORIZED 8Y THIS PERMIT 61UST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � Everett,'vVA 99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAY riE <br /> Phone:259�BB10 CANCELLED BY THE CITY UPJN ANY STOPPAGE OF WORK ON THIS <br /> I PR�JJECT OVER 90 DAYS DURATION. <br />