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( � <br /> Date��q P„��,�wo,�sP,,.,,p�, t`�,)/�j`[1�7,__ <br /> APplicatlon For uin� oca� + ._!J�/Z�_�7 ��_ . <br /> PUBLiC WORi�S PERMIT P����=�Y���=F�� ---- - - <br /> .o�.,�F�� s_. ___ <br /> LesS Appl.Fne VniJ S ___ <br /> Print or Type Only e:,""`�°°` s ZC'Q`• _ <br /> C-I�S/1!�—/-/r=1LYJ �N�- IULCL��� 4[ p/� � /lI✓✓�/�� /II /dPIC O d 'S'VC�J � <br /> Ownei Mailing Addicss Ciry 7_ip Phone <br /> �a w� �, <br /> Applica�t Mailing Address City Zip Phone <br /> r <br /> Describe Proposed Work _ �PrAI .S�(� ;uf�,fJ��/� Lry� �_��f� r,r//�� .,�_. <br /> ✓ <br /> Project Adtl�ess jif knownl �ZC L { �"���4� `,.�-- � <br />� A�tach four IA� copies of plans for proposed work � �raw to scale and note the lollowlno as applicable: � <br /> • Property Lines • Centerline ol sveet � <br /> • Outline and dimensions ol all existing and • Indicete No�th <br /> proposed sirucWres on the lot • Show any proposed yrading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WflITE BEIOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 7.All calls for inspeclion shali�e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in acwrdance with this permit and current City of Everetl Design and Construction <br /> Standards and Speci(ications. <br /> 3.Call Location Underground Service 48 hrs.be�ore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> d <br /> � <br /> � I <br /> O <br /> � <br /> ACKNOWLE�GEMENT OF CGNDITIONS <br /> The undersigned ewner/applicant hereby agrees to hold and save harm- <br /> less ihe Ci�y ol Everett from any and all claims for damag2s, costs, <br /> � expenses. or causes o! action that may arise because of installation <br /> -(��,�,LC��C''�[.�. ��- ����� and mamtenance of ihe improvement or other righbof-way use hereto <br /> applied br and furiher ac�r�es �o remove same upon notice trom Ihe <br /> Approved lor Construc�jon Date <br /> City and to replace public property dama�ed Ihereby. <br /> �/i / <br /> / '/ <br /> i�-llf� � //-IG% /'j "// <br /> PINAL�INSPECTION Date --� �r=/�/=-- �f-�-'ii' J <br /> Approved as Construcled Signature of Applicent� Dale <br /> everett PUBLICWORY,SDEPARTMENT WORK AUTIiORIZED BY THIS FEHMIT MUST BE STARTEO WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everett,WA99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />