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J <br /> Date�9D ��� V - 1� -2..`) -5 ��n���wo«3P��� ,�/.;�,� -f�,,Z'!9I � <br /> � eia�-oeo�..—7-Qlai�,.� <br /> r� Application For _� _ <br /> P� EE��..IC WORr:S PERl1NIT P°°"""°'�_``° S _ <br /> Tatal Fee <br /> � LasSAppl FeePald S — <br /> �= e�-Q� � <br /> Yi O O G O L � � �" Balance Oue S <br /> 5'- [� O O :(J O O � G �� — <br /> Prirt or Type Only� ,�; o o .; o c� c5 �'; N <br /> �-'� :,'.s� m ti �' u� � ,�,''; ai � <br /> ��� �.: .v �+n � +n c� <br /> ;-_� Kr�r � � ��n3('� F�,�le�,��"=T ,��,N-�1 �1�C�3� 1S� -sp�'�— <br /> Owner � �`� hAadii#g`t�.�df�su' � i y Zip Phone <br /> O O 4� C'� S u� U� "y V <br /> .-r O t� G] �� UJ � C7 M— O :i f i = <br /> \ O .._ J li I ��- �-� Q O W ' <br /> O :tC (u fi T i:.l (J _L _2 � !JJ �� f..l <br /> �r � -- _ <br /> q�plicaM Mai6ng Address City Zip Phone <br /> Describe Proposed Work _��P�,U��� , 1� /N(� La f ,� n� s. �� _ <br /> o� <br /> -- � <br /> G�,Zp — 15"TH S�e�r � <br /> Prc;:ct Address(if knowr` ,_ <br /> Attach four(4) copies of p'ans lor proposed work- Draw to scale and note the followinp as applica6le: � <br /> • Property Lices • Centerline ot street ♦A <br /> • Outline amJ dimensi.�ns of all exis�ing and • Indicate Norih �� <br /> proposed structures un the lot • Shov+any proposed gredirg changes <br /> • Existing and propesed utili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> � PF�iMIT COPIDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advanc?•phone 259•8810. �\ <br />� 2.AII work shail be performed in accorJance with ihis permit and c�rrent Ci�y of Everelt Design and Construction ♦ <br /> Standards an�Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUM6ER 1•SOQ•424-5555. � <br /> M <br /> � <br /> � <br /> M <br /> Yr <br /> ,\ , ACKNOWLEDGEMENT 7F CONDITIONS <br /> ��[ <br /> n� — The undersigned owner/applicant herety ayrees to hold and save harm� <br /> � `Y.— -- less the City ol Everelt from any and all claims for damac�es. cosis, <br /> expenses, or causes of aCtiun that mey arise because of �nstallation <br /> r and maiNenanc? of the improvement or o�her righl-ol-way use hereto <br /> �� �'��� C�� � ' � C1� applied for and iurlher agrees to remcve same upon no�ice Irom �he <br /> Approved for Cons!ru � n D2te Cily and to replace public property damaged thereby. <br /> � /�� <br /> y, ---- -� c� <br /> .��'�-�- a �--�? / / � , /o <br /> FINAL INSPECTION Date C����-�l��f� � ��—�" <br /> Approved as Consirucled Signalure of Applicant Date <br /> WOHK AUTHORIZED BY THIS PERMIT MUST B[ STAR'fED WITHIN <br /> everett PUBLICWORV<SUEPA.9TMEN? 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO GOMPLETION. THIS PERMIT MAY BE I <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY'S fOPPAGE OF WOFK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />