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Date '�` .li� p p <br />Apalication Fur <br />PI�BLIC i!1/ORKS PERNIIT <br />Print or Typ� Only <br />�I �.�m � ��n���tlt �� �c�X� <br />Owner Mailing Address <br />Mailing AtltlreSS <br />City <br />'S 7 ,, <br />�`'�—/�c. <br />{'�uUIIC VlpIFS {��`rnli <br />i <br />oi/agy �oen� , []/ � rl/_._ <br />iM ��iic Worksf� ' "�� <br />ro�ri F�e s <br />_v;s' Appl Fcc Paia S <br />�alance oue $ �-j l�nb <br />Phone <br />ry ap Phone <br />Describe Proposed Work ��� / C)/� c—!'� � 'T � �_%� / LT1 �C� _ <br />Projed Address (il k�own) /�/ -r��% '" / ��� �,t� S�C <br />Attach four (4) copies o( plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines tl Centerline ol stree� <br />• Outline ard dimensions of all existing and • Indicate North <br />proposed s;ructures on the lot • Show any proposed grading chanyes <br />• Existing and prr�posed ulilities • Show measuremerts <br />�1� <br />PER(�ii' SONDITIO:JS <br />1. All ce�', "or inspection shall be made 24 hrs. in advance- phone 259•881 Q <br />2. All work shall be perturmed in accordance with this permit and current City ot �=verett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. befcre you dig. TOLL FREE NUMBER 1-800•424-5555. <br />GL.I i�.i-P i i (��I I� I i I`1' E��iIY llli t�L!t i t I-� �'��,! I-4 ii ,_. <br />3t flil- I 11� I L(� Uf I i ��1� I Hi�Itlr <br />�� P I-Ut'I 1� llki-711'ftl�l-� �+1'-�If.hl r1S I-I-��i�,'� Ii �� �� � _ <br />=:��IY LO'f L'RALE (.!-1ilP4GES I•IUST B� i-1F'F'i �, i_ <br />!'tli-sLTC k�'F'k:5 L�I��F'FCIDft., <br />�:.h:'EP C:;l:l1' !iTF:EE`I'S !';I._I=AN AT F11_!. l"IiiF:' <br />IP�IS'TAI_I_ WAI�,�:� .' � c �I �i�l�.� �t a;� i _i,i ;; �� ��_ ! 1 C�i��l <br />i•�r,k._E:: �UFF il�'�.i�%I '���� �� � 1 1:�;� li I' i I:�:_! i — I-'tL- <br />..,I . '..':' r p., ,-,.I,,� -n_ir. �,., <br />�L� <br />ACKNOINLGDGEMLNi OF CONDRIONS <br />�ihe undersignod ownedapplicant here6y agrees to hold and save harm- <br />— Iess ihe Cdy of Everett from any and all claims for d:mages, costs, <br />��-�// � � i� expenses, or r.auses of action Iha� r�ay arise because of installalion <br />/ � % � -� y and maintenance ol the improvemem or olher right-of-way use herelo <br />C'j�� /��`� �` � � G�`} applied for and iurther agrees to remooe same upon notice Irom the <br />ConsVUction � �a�e City and to replace public property damaged ihereby. <br />„_e <br />FINALfNSPECTION U <br />Approved as Constructed <br />everel[ PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-II810 <br />� F� /y'/' , %>. /� ( <br />Date �U�:,��.i�� ��/�-(�����i "//�C"/�J� <br />Signature o( ApplicaM � <br />WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITl�iIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 70 COMPI �TION. THIS PERMIT �v1AY 8[ <br />CANCELLED BY THE CITY UPON ANY :�. iOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 D;�YS DUFAIION <br />