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Date Yf^� , / j C�� <br />}� <br />Appltcation Far � <br />. PU�LlC W��KS PER9lilli <br />Print or Type Only <br />:y • ` <br />C .e�� .h'l�:P �� __,,. , . . <br />Owner MaiHng Address City <br />�.1��- �-lw.c�K <br />Applicant Mailing Address � City <br />Descrihe Proposed Work L-��+M..c'-f•2s-rv\ �-r/� � <br />� <br />Proleet Address (if known) ~1� — S^ �/ '�= Z- /�?/�_L <br />�'. I <br />PoOIIe Warb Peimiu a� — �3i <br />BICp. OfDt � �+ �.�� <br />Pu01iC W014a Fe� <br />Totu Fe� 5 <br />LeasAool P�� PaiC 5 � <br />Balann0ua $��3 //L_ <br />Attach four (4) copies of pians for proposed work • Draw to scale and note the lollowing as applicahle: <br />'� Property Lines �� Centerline of strec! <br />• Outline and d;mensions of all existfng and • Indicate North <br />�. proposed structures on the lot • Show any proposed gradtng changes <br />• Existing and proposed utilities • • Show measurements . <br />Approvetl a5 <br />everett <br />� <br />��y <br />Phone <br />2s� - <br />Phone <br />PERMIT CONDITIONS <br />1. AII cal�s for inspectian shall ba made 24 hrs in advance • phone 259•881 �. . - <br />2. AII work shall be pertarmed in accordance with lhis permit and current Cit)� at Everett Design and Cons[ruction <br />Standards and Specificatfons , � <br />3. Call Location Underground Service 40 hrs beforn you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�j�, c.T.c. .Ga'r� Lt'pz.�. �o G� <br />��Z`r� 6-a25- db <br />c/art�. � .Q�a/ecc•�l' ��xr✓ <br />Date <br />s�� <br />�� <br />� <br />� <br />� <br />� <br />� <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />The understgned owner/applicant herebyagrees to hald and save harm- <br />less lhe City of Everett Irom any and all claims tor damages. costs. <br />expenses, or causes af actian that may arise because of�instailatfon <br />anA mairtenance ol the improvement or other right•af•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to raplace puhiic property damaged thereby. <br />;TION Date "� <br />onstructed � Signawre of plicant � ate <br />PUBLIC WORKS DEPARiMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED ANO ?HEREAFTER IS T� <br />Everett, WA 98207 ' BE DILIGENTLY PURSUED TO COMPLE'!ON. 7NIS PEfiMIT MAY BE <br />Phone: 259•8875 I CANCELLE� BYTHE CITY UPON ANY ST�PPAGE OF WORK ON THIS <br />` PROJECT OVER 90 DAYS DUFATION. <br />