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.________ _ _ __ _ _ <br /> � <br /> I <br />�w. ' <br /> .��.'r' . . <br /> 1 <br /> /����� � <br /> b `l�-l•/ <br /> � Date.�-L_L: 1 a„m��v,o,�sv�,m:�. �/ �� � i� <br />. . eitl9.Deo� • �—�`�SI.Ct.S[].._�_-- <br /> � APplication For <br /> PUBLIC 1iVORKS PERMIT �°�°�W���=F�� - <br /> ,o�a�F�� s_ _ <br /> Lees Appl.Fee Pmn S <br /> Print or Type Only �,,.,,,,,,.o�„ s <'�'G�� — <br />� �'���e�l`�.�� � � �'��-�I��,� i�� r� �r� 1 ��i Ir7�t'z.r� �Iv'� ����a�a <br /> Owner Maihng Address Gi�y Zip Phone <br /> _,L��`���.i�_CC:�-�.—�(� <br /> Applirant Mailing Address City Zip Phone <br /> Descnne Proposed Work ��—�— l 1' J� I�__���.-�� I�C�Y J <br /> t�7// — ��/. � � <br /> Project Address lif known� • J - i-�L'f.� � ( - � <br /> Attach four(4)copies of plans for proposed work� Draw to scale and note ihe follo•viny as applica6le: � <br /> • Property Lines • CeMarline of street � <br /> � • OutGne and dimensions ol all existinq and • Indicate North <br /> proposed struclures on the lot • Show any proposed ;:ading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for insGection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and cu«ent City of Everett Design and ConsVuction <br />� Standards and Specificetions. <br /> 3.Call Location Underground Service 48 hrs.be'ore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 0 <br /> �w <br /> _/ <br /> a <br /> a <br /> 9CKN0`NLFUG[��1[NT OF CONDITIONS <br /> ��p The undersic�ned ovrnedapplicrm�hereby a9rees to hold and save harnr <br /> less ihe Gty of Everett f�on any and all claims for dam2qes, cosis. <br /> , ezpenses, or causes ot aclicn ihat may arise because ot installation <br /> ' l„` �/Y�,., ,,�'`,_ L ,�,� _�;/ and mnmtenance of the improvement or other righl�ol-wa�d use hereto <br /> V � applied fur and furiher aqrees to remove same upon not�ce from the <br /> Approved for Construc � D te City and to replace publ�c pwperty damaged thereby. <br /> i <br /> 'i� �`/-6S � —� � <br /> FINAL INSP TION Da�e ���1 �'-- <br /> _.__ <br /> Approved as Constructed Signa�ure ol Applicant Dale <br /> everett PUBLIC WORKS DEPARTMENT �✓�Ph AUTHORI'L[D BY THIS PERMIT MUST BE STARTED WRHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PGRMI7 IS ISSUED ANU THEREAFTER IS TO � <br /> Everett.WA98201 BE )ILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M�Y aE I <br /> Phone:759�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> PROJECT OVCR 9G DAl'S �URATION. <br />