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� i •, <br /> I �� <br /> �a <br /> � <br /> ,i <br /> � <br /> Date��'q ���,�,���.�vo„sN.•�„��_ _3/�����_ <br /> �pplical�on For ma� ocoi e _�/_ Z-��7...__-.. , <br /> ! <br /> �UB�LIC WORKS PERGVI6T P��b;oWF����.,, S_— --- _ ;;;� <br /> . ssAnpl FncPam 5 <br /> � <br /> Print or Type Only c:+�,��,.o�� s zO-- __ <br /> s- �S z�,c ��ra�,�r�rPP h,i� r�,1l.�r�,� ,��o�� jys-oa3a <br /> Owner Mailing rlddress Ciry Zip Phone <br /> Sa � � :;; <br /> Applicant Ivlailing Address City Zip Phone ; �`g <br /> �b� <br /> Describe Proposed Work � PiA1 Si1�n.�(��y�1���I__���� � �IGW I���v� <br /> � <br /> Proiect Address lif known� -J�C'� -� ( � ��+�� �ll � <br /> Attach four�4)copies ol plans for proposed work� Draw to sr.ale e�nd n�te ihe foltowine� as applica6le: � <br /> • PrOperty Lines • Centerline ol sireet � <br /> � Ouillne ard dimensions of all existin;� and • Indic�te North � <br /> proposed SVUC�ur�S on !he lo� • Show any p�oposed grading chanqes <br /> w Exi;tmg and prOposed utildies • Show measuremenls � <br /> DO NOT�NRIT[ BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Constructic� <br /> Standards and Specifications. <br /> 3.Call Location Unaerground Service 48 hrs.before you dig.TOLL FFlEE NUMBER 1•$00•424•5555. � <br /> 0 <br /> � <br /> �w <br /> M/ I <br /> � <br /> � <br /> ACIMOWLEDGEMENI OF CONDITIONS <br /> Tnu undersi��ned oH�ner/eppliaent horeby agrees to hold nnd saco h;�nn- <br /> Icss Ihe Ci�y ol Everett Irom any anJ all clalms for dama�es. co5is. <br /> � �/1,f expenses. or r.auses of action that �nay anse bec�use of installation <br /> r/(�-�C/ i'iYC�` //_ /G=�4`ri and maintenance of Ihe improv„ment or olher righbobway use hereto <br /> `� �� � -� applied for and further aqrees to remove same upon nolice Irom the <br /> Npproved lor ConslruC�ion - ���e Cily and to replace pubhc property damaged ihereby. <br /> n'� �"�r�— / <br /> � %-�/:,%=�• ; <br /> FINAL�INSFECTION Date ��L�� ���G-L-l�t� ����.�C% <br /> Approved as Construc�ed Sign,:ture of Applicant�� 'T Date <br /> �•verett PUBLICWORKSDEPARTM[NT WOAK AUTHORIZED BY THIS PERMIT MUST BE Sl'ARTED WITHIN <br /> � 3200CedarStreet 1H0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretLV�'A99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT MAV BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPOfJ ANY STUPPAGE OF WORI( ON TH�S <br /> PROJECT OVER 90 DAYS DUFATION. <br />