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'_� <br /> i <br /> � <br /> ( a <br /> :r <br /> I <br /> I <br /> I <br /> I ,�'i� <br /> r <br /> Y <br /> � <br /> �r���i—V\J �C C ' <br /> Date ���m��wo,w�.��,m��. :1 J�-1 <br /> t-�� -�___ . <br /> AppliCalion Fnr �in� oea�.. _�l�� _�1 . <br /> ! <br /> PUBLIC WORKS PERMITi P°°°°w°,�=�Ce --------- <br /> iolal(rr g'.------ <br /> Less/�.�ul Per PaiO S__ <br /> ^� O <br /> Print or Type Onl�� e��.,���o��� s G �� _ <br /> ' <br /> `a����at5 � � I����n n�u��'� l�rn n�c -��,� �s�c;� <br /> Owner Mai{in� A�dress Cdy Zip Phone . <br /> AppliCant Mailing Address Cdy Zip ��phone � <br /> Describe Proposed Work �J=�/ l� � l—�1�,� ��� d-�l __�� �� <br /> II <br /> Project Address(il known) _ / 7-3�— S��PV'.�•�_ � <br /> � <br /> AQach four!A) copies ol plans for proposed work- Draw lo scale and note the lollowmg as applicable: � <br /> • Property Lines • Centerline of siree� � <br /> • Outline and dimensions ol all existing antl • Indi�ate North <br /> proposed slructures on the lot • Show any proposetl qradiny chanres <br /> • Existiny and proposed ulilities • Show measurements � ; <br /> DO NOT VJRITE BELOW iH15 LINE O I <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspecLon shall be made 24 hrs.in advance-phone 259•8810. � � <br /> 2.All work shall be pertormed in accordance with this permil and current Ciry of 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 <br /> � I <br /> � <br /> � <br /> O <br /> a <br /> � — ACKNOWLFDGEM[NT OF CONDI710NS <br /> The undersigned owner/applicaN herehy agrees�o hold and� `arm- <br /> less the Cdy of Everclt trom any and all claims Ier damage�. cosls, � <br /> � . ,� expenses. or causes ot actien that may arise bacause ul installation - <br /> �/ < .a<� and maintenance of �he improvement or other riqhbol-way use hereto <br /> �������� ���<�/�=-' ' � �''�� applied for and furiher ac�rees to remove same upon notice Irom �he � <br /> Approved fo�Consfructi n Dale City and to replar.e Public property dama�etl Ihereby. I <br /> C � <br /> �� � - 3���f `� �C=�� �� <br /> FINAL INSPECTION �Date <br /> Approved as ConstrucNed Si,n� ur nl Appllcant ate <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> � 3200CedarSireet 18C DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO �. <br /> Everett,WA98201 8G DILIGENTLY PUI7SUED TO COMPLEfION. THIS PERMIT A9A\' BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br /> PP.OJECT O'vER 90 DAYS DURATION. <br /> � <br /> I <br /> � �' <br />