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� � I <br /> � � <br /> I <br /> E. <br /> i <br /> Yc I <br />�t. � <br /> _ j <br /> Ir <br />�i. . y� /�A <br /> �a1Qy��y�� Putil¢YJo�hs PoCrm�il�•] / �l/// —� � i <br /> C����:. aPPIiCalien For oin� Deni.• . r�1 /_�(LQ��— �, <br /> PUBLIC WOR�(�:� PERMIT --- — -- <br />� c PubLc Wmks Fco � <br /> Iicpl Fee 5-- — <br /> Lest AnVI.fr,�['aip $ <br />� 9alnncr�ue � l��'���� <br /> Print or Type Only -- <br /> �� , �t��� ��e���5 i��a�� ,r �i�1��i��r�a i� �'=� i,t� ��-�� <br /> �t�0 er Mailing Atltlress Gty �ip Phone <br /> 75``��-�.�Z� 7r�F_—�Z—����/��_ <br /> Applicant Malir.g Pddress Ciry T— Zip Phone <br /> � �_ �� �/'1 � ,.�) <br /> Describe ProFosed Wo�k � -�— ��1 ��� �� ��� =��.'{, _��. <br /> Prolect Address(if knownl �i2� .__J f�_. ����- ��f� _ � <br /> � <br /> Attach four(41 copies ol plans for proposed worx Draw to scale and note the followinq as applicable: i <br /> • Property Lines � Centerline of street � <br /> • Outline and dimensions of all ezisting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed gratling changes � <br /> • Ezishng and proposed utildies • Show measuremen(s � ' <br /> DO NOT INFITE BELOW THIS LINE <br /> PERMIT CONDITIONS O II <br /> 1.All calls for inspection shall he made 24 hrs.in advance-phone 2S9•8H'I Q � i <br /> 2.All work si�ill be periormed in accordnnce with this permit and curreM Ciry of Everelt Design and Construction II <br /> Standards and Specifications. , <br /> 3.Call Location Underground Service 46 hrs.before you dig.TOL�FREE NUMBER 1-500•424•5555. � I <br /> O <br /> �w <br /> _/ I <br /> � <br /> re � ' <br /> �p l�CKMOWLEDG[MENT CF CONDITIONS I <br /> �'�0 Thu undersigned owneriapplicant hereby a9rees to hold and save harm� i <br /> I less ihe Ci1y of Everet� Irom any and all claims tor damages, cusis. , <br /> /� e�uenses. or causes ol ar.tion ihat may arise because of installation I <br /> L � � . � end maintenance of the impwvement or other right�ol-way use hereto <br /> � � "� /l�`�' .�� ' � � � � app�ied lor and furiher agrees to remove same �pon notice from the <br /> Approved for Conslruction Da�e City and to replace public prope�ty damaged �hereby. <br /> % / <br /> c�=�-- �'-/-FT �_-� � f <br /> FINALINSPcCTION Datc "� �—�-� ��f � �,r� � <br /> Approved as Construcled Signa ur - I Fpplic��nt � Da <br /> �ver��lt PUBLICWORKSDEPARTMENT `NORK AUTHORIZED f7Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CeAarSlreet 180 DAYS OF DATE f'LRMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA982r)1 �E DILIGGNTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> CANCELLEG �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-bf31) PROJEC-f OV[R 90 DAYS DURATION. <br /> I <br />