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;� <br /> i <br /> i '� <br /> � "' <br /> � =`'� <br /> � <br /> � ;,�; <br /> ' � '� <br /> � <br /> Date_� v�rnn � aubi,r.wo,FSFe,mn�.7� t7�J� rG <br /> ApPlication For em� o�n+�• —(�n,2S1=j � <br /> � _—� <br /> PUBLIC WORKS PERNlIT v.�L��W�«=F�� --- ------- <br /> .o�a�F�� s_. _ <br /> lvss Appl Fee Paa 5 <br /> ^l C�C� <br /> Print or Type Only e,�,�«o�� s=L'— _ <br /> �.�. �) (� � ��f E'v �l: _ �!l�tl ��- ?�9�1 r�ll� .��,�-9�05 _ <br /> p� er Mailing AAdress City Zip Phune � <br /> Applicant Mailing Addre;s City Zip Phone <br /> Describe Proposed Work � .� �1'c`-e-/7ULC-.L./�� !�L(,!-'� , <br /> Project Add�ess lit known� 7 7�Z � S �—� AVE, w, _ � ��� <br /> � <br /> Attach lour 14)cnpies of plans for proposed viork- Draw to sr.;�le and rete the follo�ving as applicable�. � <br /> • Property Lines • CeMerline of street � <br /> • Outline and dimensions of all exlsting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed gradiny changes <br /> • Exishnq and proposed utilities • Show measurements � <br /> . DO NOT WHITF BELOW THIS LINE � <br /> PERMIT CONDITIONS O I, <br /> 7.All calls tor inspection shalt be made 24 hrs.in advance- phone 259•8810. � � <br /> 2.All work shall be pertormed in accordanc� with lhis permit and curren!City ol Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � ' <br /> O I <br /> �w <br /> �/ <br /> � <br /> a . <br /> t ACKNOWLEDG[MENT OF CONDITIONS , <br /> (�� The unders�ned owne�/apPllcant herehy agrees Io hold and save hanm �i <br /> less ihe City ol Everett from any and all claims tor damages, costs. <br /> � , expenses, or causes of aclion that may arise because ol installa�ion <br /> � /�/ ��C�'� �� ' and maiNenance of the improvement or o�her right-ol-way use heretc <br /> `��� ��Jf7'� ""�� -��—•��� applied lor and luriher agrees to remove same upon notice irom the <br /> Approved for Cons r��ion , Date City and to replace P��blic property dama9e 7 Ihereby. <br /> i�]� � '/ �� �-� cf j � <br /> FINAL INSPECTION Date ��1 �� � Z 7 � <br /> P.pproved as ConstruCted Si9nature A.pphcant Date <br /> everell PUBUCWORKSDEPARTMENT VJORK AUTHQRI2ED BY THIS PERMIT MUST BE 3TARTED WITHIN <br /> � 3200CedarSireet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,VJA9A201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> IPROJECT OVER 90 DAYS DURATION. <br /> I <br />