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/] �p/� ,� � <br /> Date_YJ.I_, 1 � i�,�o�.,.w�,�,r«,m�i. [�� <br /> AppIiCB�ion For emu o.m •��� 7�`1 J _ <br /> PUBLIC WORKS PERMIT �ueTolelfee��� : <br /> Le����OD� feeP�iJ S <br /> Print orType Only a.�.��.o�a t_ <br /> ia��k� I ��. ���. s� � A��. ��A� �t,� ���- �g�� � -�sr� <br /> �Ow�ar Mailing Add�ess City Zip Phone <br /> L�A ` _ <br /> Applicant Malhng Adtlress City Zip Phone <br /> Deacrit�e ProP-oae or �I��l�Il l� 1 � l _�YV�r"y��(�F t�k�l� � �j_fyr �� _ <br /> T <br /> Pro�ecl0,ddreasplknown� . �-� I� Y�j �' �f��• � <br /> Atlech lour�4)coplen 01 plene lor propoaed work• Draw to acele and note the lollowing as appliceble: � <br /> • Property Linee • Centerline of strael � <br /> � Outline end dimenslons ol ell exlating end • Indl,:ele Norih <br /> propoeed structures on the lol • Show any proposed prading chenges <br /> • E�Istlnp end p�opoaed utlllliea • Show measurementa � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inepecllon ehell be mede 24 hra. In advence- phone 259•887 5. � <br /> 2. All work ahell be per�Ormed In eccordence with Ihis permit and cunenl City of Everett Design and Conelruction <br /> Slen��rds and Specillcetiona <br /> 3. Call Locellon Unde�g�ound SArvice 48 hrs, be�ore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �l�c�./� Cf/C�/'�S �E<�/•L"'// /U�J/ ��j�t�'�U��=� ��j�� O <br /> �// � <br /> 2 �✓ <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signrd owner/Boplicant hnreby ag�ees to hold and seve hnrm� <br /> less ihe City ol Eve�eO Irom any and all claims lor dnmages. cos�s, <br /> PxpenSCS. Or Cau5e5 0� eCUDn �ha� mxy erise because of instellation <br /> end mamlenance ol Ihe Improvement or other nghPol-way use herelo <br /> Approved lo�ConsUucticn Dale appiied lor and furlher agrees to remove sama upon notice Irom ihe <br /> City and to replece public pioperty demaged thw�ehy. <br /> FINAL INSPECTION Date <br /> Approved as Construr.ted Si9netu•:r ol Applicent Dale <br /> everett PUBLIC WONKS DEPARTME�VT WORI' AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 190 D�\VS OF DA7E PEFMIT IS ISSUEQ AND THEREAFTEH IS TO <br /> Everett.WA 98201 B[ DILIGENTLY PUFSUED TO COMf'LEiION. iHIS FERMIT MCV BE <br /> Phone� 259�8815 CANCELLED BV THG CITV UPON ANV STOPPAGE OF WORK O� THIS <br /> PFOJECT OVEF 90 DAVS DURATIDN. <br />