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� � � <br /> [� H --�7--'f /--''- <br /> ru�i�c wo�ks vo�rnn. <br /> � � � Date---- � - <br /> er.a oeo�.+ <br /> Application Por .,, <br /> y � U—_ <br /> � y � Pt��@.JC !�!(3RKS:�PERNiIT P°°:�„"�F��`eO g 70 <br /> �H � ��•,:��:,� F��.,:,�,� s—�,_,--- <br /> vJ N , o [3.�i,�.�,,o,,.. s—��— — - <br /> �{Cy � nfl.'7� OI 1Y[�c �fl�% -. r, r, —_—__ <br /> l•J Q � �� f�`I �I <br /> Hd ( • '� � S� <br /> O H `—L � ��E � r^ — i;i� 5 � � <br /> H � o -c/a �, , /rl/'r� �,7' /��,�� ��.��;� _ � ��{-� <br /> H` n Owner Mai{ing Add�ess c� ;p .., �Y Lp Phone <br /> � H � ' , .J � , <br /> � y z `��7"L_. �'_i i= �'�. �,� <br /> y-y Mailing Address City Zip Phone <br /> b Applicant <br /> O H <br /> c� C� <br /> �� t+ Desyri�Prop�d Work , � 7 � Q� - <br /> Z H !n� � . <br /> f/( P I�UYt.si�-P� .rJ�%U'y �.� � <br /> HO [n � <br /> �—/ ��yy �of� <br /> k�roject Address(il knovm) ������` �^��� � <br /> Allach four(4)copies of plans lor proposed work- Draw to scale and note Ihe foilowing as applicabte: i��w <br /> O Property Lines • Centerline ot street �� y <br /> • Outline and dimensions ot all existing antl • Indicate North d/ <br /> proposed struclures on the lot • Show any proposed gratling changes <br /> - • Ezisting and proposed utilities • Shaw measurements � <br /> i '�� <br /> DO NOT WRITE BELOW THIS LINE A <br /> s�"+ V <br /> , PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> I �� 2.All work shall 6e pedormed in accordance with inis permit and current City of Everelt Design and Construction <br /> � ' Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> L� ��� �rOlr-ed �J Ll9 L Q/!!T�'�L � � � �'7 l J � � <br /> 'o � <br /> � I <br /> �� � G �, ��� . ` <br /> � s �<.: �._ /, ..�_ �, � s , �� �.._lre.C� <br /> � � (�. '� <br /> ;�, ;�_�( �,-F �-E-.- � s l� � <., .� � ,-` f � -- C� <br /> _.._ � , �� /7 �,(�� �"' � <br /> i ! <br /> ' '�'�� ACKNOWLEUGEMENT OF CONDITIONS ��, <br /> �� ' � I <br /> The undersigned owne�/applicant hereby ac�rees to hold and save harm- <br /> \. , less the City of Everelt Irom any and all claims for damages, costs. <br /> � ezpenses, or causes o� action that may arise hecause of installation <br /> �l� // ; �� /�l/��/ � <br /> and maintenance ol ihe improvemenl or other righ4of�way use hereto <br /> C� applied lor and further a9rees to remove same uUon notice from th�� <br /> �pproved�onsiruction D°��' City and to replace public property damaged thereby. <br /> ���- ���/ /,/ \ ' , <br /> �� 7 �%�� L�l I�/�� rL _A� � �k I� � a Y> ; (� �� i. <br /> PIF:AL INSPECTION ` � i a[e . <br /> iy>proved as Conslructed Si9naiure ot Applicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIId <br /> � PUBLICWORKSDEPARTMENT ta0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER Ig TO <br /> ,/� 3200GedarStrcet 8° DILII:ENTLY PURSUED TO COMPLETION.THIS PERtdli I.L\Y HE <br /> �^ tYf Everett,�NA 932M (;qNCELLED BY TFic CITY UPO\ANY STOPPAGE OF CJORK CN THIS <br /> Phonr.:259-t7B10 PROJECI OV[R 90 D�1YS DURnTION <br /> __ _. .______.. i i <br />