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_ _ � <br /> � ,. <br /> � �"a <br /> ;� <br /> � <br /> I <br /> i <br /> I <br /> I <br /> f/�Q Q � � <br /> Date_'�-�0 a„oo�wo,k.���,m�i. ��— J1 <br /> Applir,ation For <br /> J1�f9 Deni.a ����L�__ �' <br /> PUBLIC WCyRKS PERMlT ��v���w���=���- - <br /> .o„�F�� S- — ' <br /> Less AOPI Fqr Pau1 S �^� <br /> Print or Type Only ea�e��eo�� s �C��' __ � � '�� <br /> Y <br /> ��fL�I FI C� `��1.�f5 � ( "� �> 1�9D �1k 1 ��ll�Z/�+I'I �)I,f'� ��`7� .�`�`' j � <br /> Owner Nading Address City 7_ip pho�e j ' <br /> Applicant Mailing Address Ci�y Zip `���ne ' �� �i � <br /> Describe Proposed Work ��' . l-� �I ����'��,1 ����1,���_ <br /> Prolect Addrass(it knownl � ?��� S�AVE W � <br /> — � <br /> Attach four(4)copies ot plans for proposed work� Draw to scale and note thc following as applicable: � <br /> O Property Lines • Centerline of street � <br /> • Outline and d!inensions ol all existing anA • Indicate North <br /> proposed structures on;he lot • Show any proposed grading changes <br /> v E::isting and pruoosed utilities • Show measurements � �� <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O I <br /> 1.All catls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All��n��rk shall be peAormed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and SoPcsicailons. <br /> 3.Call loc,:[ior�Underground Service 48 h,.before you di�.TOLL FREE NUMBER 1-800-424•5555. � <br /> O <br /> �w <br /> �/ <br /> � <br /> a <br /> �CKNOIVLEDG[MENT OF CONDITIONS <br /> � The undersigned o�vncUapplican�herehy a9rees to hold and save harm- I' <br /> less the City ol Everell t�om any and all claims for damages. costs, j <br /> expenses, or causes ol ac�ion that may arise because of installation <br /> — /i j/h j �_ �_ �,., and ma�ntenance of the improvement or other riqh�-of-way use herelo <br /> ' /J /�'� applied for and fudher agrees lo remove same upon notice from ihe <br /> Appruved lor Construction" Date C�ry and to replace pubGc property damaged thereby. <br /> / / <br /> !�!�-� /C� �- d-,' . / <br /> FINAL INSPECTION Da;e �� — ���� � <br /> Approved as Constructed Si9n ie; o Applican — � Datc <br /> everett PUBIIC WORKS DEPARTMENT WOFiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cedar5lreet �80 DAYS OF DATE PERPAIT IS �SSUED AND ThiEREAFTER IS TO <br /> Evereit.WA99201 ❑E [nLIGENTLY PURSUE� TO COMPLE?ION. THIS PERMIT MAY BE <br /> Phone.:259�8810 �ANC[LLED BY THE CITV UPO� ANY STOPPAGE OF WORK ON THIS <br /> PRCJECT OVEf?90 DAVS DURATION. <br />