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-T <br />8��sti <br />L81doOfPIR <br />PemAl • ����� <br />Date 7405 <br />Application For fee PERMIT PUBLIC WORKS eP.,d t ?� <br />Print or Type Only Ar <br />7f sE Ev.mrucwfil qf:6 Aq 35? -650d <br />�Rpt,�Itj WSOM Nomes lrJG L�R12 city zip Phone <br />Meiling Address <br />Owner— <br />S �Ytiti� r 15 00City �/ Zip Phone = <br />_ O <br />Melling Address <br />Applicant <br />5 i tiGLC �✓iMlG PCS!►�� --rn <br />Describe Proposed Work�uc------- <br />Wrrnn <br />�.T • �, m o <br />Imo: r <br />Project Address (If known) n <br />• Centerline of street = y <br />work • Draw to scale and no <br />to <br />Attach four (4) coplas of plans for Proposed the following as applicable: <br />9 property Lines • Indicate North m <br />• Outline and dimensions of all axisting end 0 Show any proposed grading changes C = <br />proposed structures on the lot 0 Show measurements <br />• Existing and proposed utilities o = <br />WRITE BELONI THIS LINE <br />DO NOT K In <br />wad O T <br />PERMIT CONDITIONS ♦ T <br />1. All calls for inspection shall be made 24 hrs.In advanco Phone 259.8815. Everett Design and Construction <br />Fi <br />2. All work shall be performed In accordance with this permit and current Ci Y of �rn <br />Standards and Specifications <br />3. C811 Location Underground Service 48 hrs. before yrn <br />ou dig. TOLL FREE NUM 1.800.424.5555. ��\] CC r <br />V� <br />C D <br />OS <br />CLZ <br />O <br />�i <br />r <br />M <br />m <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold end save harm - <br />ass the City 01 Everett from any and all claims <br />rise because damage, Costs, <br />expenses, or causes of action that may <br />}—appliedlfor end furthFrance of lereIMP agreesv to remove nt or tsame UPon notice sfrom the <br />��damaged thereby. <br />Date Clly and to replace public pr e y demag <br />Ap ed for Con 1 uc <br />l�l� glo _ Data <br />Date <br />FINAL INSPE TION Signature 1 Applicant <br />Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />ER IS TO <br />ATE PERMIT <br />AND <br />everett <br />REAFT <br />PUBLIC WORKS DEPARTMENT BE DILIGENTLY PURSUED ICOMPLETION.D <br />180 DAYS OF PURSUED TOH SEPERMIT MAY BE <br />3200 Ceder Street CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Everett, WA 98201 PROJECT OVER 90 DAYS DURATION. <br />Phone: 259.8815 <br />