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Date �; a7 <br />qpplication For <br />P���,f2.` W�J�K.S � ERIVIIT <br />Frint or Type Only <br />GI � <br />i <br />.J;i�i— <br />�c �.�i�'CCi �Y1f�LC. �U. <br />. „aa.o« -- c�iv <br />Applicant <br />Mailing Address ���Y <br />n�- Ca��rN�_7� <br />Describe Proposed Work <br />Vuhlm \Yo�ks Petmd • '-9 ✓ �� / <br />eia9. 000i. + }'S 'ys-- / � <br />Public P�oiks Foo S --�_ <br />Totel Fec <br />Less AO�L Feo Paitl g -- <br />FlalanCa �oe S � �l t�� <br />�i�.=�'�� <br />Zip <br />�.c.T <br />—'� (� �-' _ 'f/,! /��7 ��� -� � <br />Prolect Address (if known) �� ihle� <br />Attach four (4) copies ot pl2ns for proposed work <br />Draw to scale and nole the following as app ic� . <br />• Property Lines <br />• Outline and dimensions of all existing and <br />propr,sed structures on Ihe lot <br />O Exist;ng and proposed uliliiies <br />ar-.:r�..��va•n <br />DO NOT WRITE BELOW Thl3 LWE <br />7, ;ylsz <br />3S� `1��i7� <br />Phone <br />/Si� <br />R Centerlinr, of stieet <br />i Indicatc ��orth <br />�) Show any P��Posed gr3din9 chang�:s <br />i Sa��w r ��asu,,.. �. t:. <br />PERMIT CONGITIONS <br />1. AI! calls tor inspection shall be made 24 hrs. in advance - phone 259•$81 5. <br />2. All work shall be Gerformed in accordance wiLi lhis peri�iit and current City of Everett Ue.��9n ��'� Consiruction <br />Standards and Sper,ifications. <br />3. Call Location Undergrcund Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424-55!i . <br />.�- _i — �7 � <br />Date <br />qpproved for <br />Dzte <br />FINAL IN�PECTION � <br />qpproved as Canstructed <br />everetl PUBLIC WOFlKS D <br />� 3200 Cedar S�reel <br />Ev�.rolL N!A 98201 <br />lPhonc:259-BB15 <br />�' <br />�: <br />AGKNO�VLEUGEMENT OF CONDITIONS <br />The undersigned owner/applicaN hereby ac�rees to hold and save harm- <br />less ihe City ol Everelt from any and all claims tor damages, costs, <br />expenses, or causes of acticn thal may arise because ot installation <br />and maintenance of the improvement or other righPof�way usz hereto <br />applied for and turther agrees to remove same upon notice irom Ihe <br />C' and t.�igPlace publip'properry damaged thereby. <br />� ��'�' Date <br />3ign�ture of Applican <br />Vj�fSRK AUTHORIZED BV THIS PERMIT MUST BE STAP.TED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREP,FTER IS TO <br />0E DILIGENTLY PURStIE� TO COi'v1PLETION. 1FiIS PcFtMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY S-iOPPAGE OF WORK ON TH15 <br />PROJECT OVER 90 DAYS DURATION. <br />.. .� <br />�{ TI <br />�--1 � <br />N 2 <br />f�l <br />U <br />�- o <br />fTl C" <br />�, <br />O 3 <br />r� <br />—� L <br />m~ <br />.. <br />Qz <br />a -� <br />.r-. �_ <br />� �� <br />< <br />� <br />ox <br />�n a <br />-i �*i <br />z <br />m �� <br />v� <br />or <br />� r�� <br />c �r <br />3 �n <br />m <br />zn <br />-i r <br />m <br />a <br />v <br />