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Oate 7g.� ���.�,�,��•�.,.s��,.,�,�. ���- GL`�_ <br /> AppliCalion For o'no Deu! • <br /> PUBUC WORKS PERMIT �'ubt4Wmk�Fle s <br /> les>Appl.Fee Peiti S <br /> Print or Type Only ea�e��eo�e s ����� <br /> vl�lliam �,�InM� M.P, rzi� �I�r�-ar� �v�-�t� q2�� 25�•3iat <br /> Owner Meiling Address Ci1y 2Ip Phone <br /> I�-,►-� �I�+-r-�� ��vs� �c��N �vu��- qezo� 2s�-�-�a <br /> Applicant Mailing Address City Zip Phonc <br /> Describe Proposed Work �YfT/IdG �"��� I'�fSYY�;�7 '�� .,�.'£•J' � C/�Vrrt <br /> hi� G� C-�IS"f, Gair{i� C �20�. �lz� <br /> Project Address(il known) ���Z �I"""'1 � <br /> _ '— � <br /> Atlach four(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centedine of street � <br /> • Outhne and dimensions of all exis�ing and • Indicate Norih <br /> nroposed strudures on Ihe lot • Show any proposed grading changes <br /> !1 9zistinp and proposed utilitles • Show measurements � <br /> DO tJOT WRITE BELOW THIS LII:E O I <br /> PERMIT COND�TIONS <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � I <br /> 2. All work shall be performed in accordance wilh�his permi�and wrrent City of Eve�etl Design anA Construction <br /> Standards and Specifications. <br /> 3. Call Location Undergrounrt Service 48 hrs.bofore you dig.TOLL FREE NUMBER 1•800•424•5555. � I <br /> 7. f1i(ly E�x is7�.vC- S ipf�dl�i K �4.nAC-e 0 .dJ/ TNE CaiJ57i'c rTia�' O <br /> pf' 7yE i�/Ei;/ ACCESS �1/np SNAtL t3E r('E/'idcEU /�j� <br /> !NE fl/�j�LiLAn�T. � <br /> S %N/S �'A�P /S G�EiivL^ Coi7/s'T.CcY72�0 D/v G�iT}/ � <br /> ,E'�c irT- Of- !✓nf/. 7NE A��t�c�n/T Coc��l� � fit O <br /> .E'EY�Ui/�E-D TL �Ernc��'f /T �iv T.fiE Fi�Ei,�i � T�E .�'C!G,: <br /> iS ,E'E�w.E'£'D F�,�' ST.�FFT n,c S:vF„ie� ,� r"c�.�ic��ES, . a <br /> � /i�4.t�Oh'dLS FO•� TNE .<'dn7r� %a BF I�j'L'lirL� �� �'/iSNiiL'GiqV ,�TAlE <br /> ��E[S(l[AT��'�/S f1P�f tl4�c'.CiE�t' �F� FAG �LiTiES. <br /> I ���ONST.euCTiON vf TirE v����`k�4J� To BE /'f� ��•�f <br /> STA�vr7�de=0 �3t'>7 ACKNOWLEDGEMENTOFGONDITIONS <br /> The undersigneA owner/applicant hereby agrees to hold anA save harm� <br /> less the City ol Everett from any and all claims lor damages. cosls, <br /> ezpenses, or Causea o1 aciion th�t may arise because of instailation <br /> , --��� t�.0 / O�j�J and melnlenance of the improvement or other right-ol-way use herelo <br /> _�,�� ��� ��Y � apP�ied for and further agrees to remove same upon notir.e Irom ihe <br /> Approved lor Construttion Da�e perty damag d jhereby. <br /> i Ci�ty and to replaCe p iblic r � $/�I�y� <br /> l �� a <br /> ��� �*�Fl�f j'� 7_F�1 (JIM-C- � <br /> �c� <br /> FINAL INSPECTION Date � �� � � <br /> Ppproved as Conslructed Signature ol Applican��r—� Date <br /> WORK AUTHORIZED BY THIS PERMIT M���T pF STARTED WITHIN <br /> evereU PUBLIC WORKS OEPARTMENT 180 DAVS OF DAiE PERM1IIT IS ISSUEU AND TNEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COt�iPLETIOPI. THIS PFRMIT MAV BE <br /> [verett. WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> Phcne: 2.59�8815 PROJECT OVCR 90 DAYS DURATION. <br /> � <br />