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Date.�..��_' � ' � Pubi¢WoiM�Permlt• 7 3�� <br /> _ ;�, ,� <br /> ApPllcation For eiao oeni . <br /> PUBLi� WORKS PERMIT Pu�bcWork�Fee <br /> Tm�i iee S <br /> Leu�ppt Fse P�iE s �I <br /> Print or Tyoe Only Dehnce0ue B ZQ 00 <br /> l � <br /> �!►rr� �X>>��� ,��r��: �_, > >i�ll � �4��. �i,r��f� � ��a�i ��'-�-?��.� <br /> Owner Mallin�7 AJdress Clty Zip Phone <br /> .�;��'rvi��"� Ti��,. .�;'L�� �`���� `,-��<<`:�� q5�,� I �'��; _,�,=�,�� <br /> Applicent Mailing Addresa Cily Zip Phona <br /> qNo. <br /> Desoribe ProPOsed Work __��1� ��� -�! l V ���'�C �� �/���� �k� �—��!�� �� <br /> . - . ,, � •�- � ,� _<; � _ _ ,� <br /> Prolect Addresa(11 known) _ 7/IB— ,�+�5/I/r.E6CI �i(/, — � <br /> � <br /> Attech lour(4)coples ol plans �or p�oPosed work• Draw to scale and nots Ihe tollowing as epplicable: � <br /> • Proper;y Lines • Centeillne ol street � <br /> • Outline and dimnnsiona ol ell existing end • Indicate Norih <br /> proposed struclures on the lot • Show any proposed grading changes <br /> • Exiatinp end propnsed utllllies • Show moasuremenla � <br /> DU NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1 All calls for Inapection shall be mede 24 hra In edvanca-phono 259•881 5. � <br /> 2. All work shell be performed In eccordance wilh thla pormit end current City ol Everett Desipn end Construction <br /> Stendarda end Speciflcntlona. <br /> 3. Cell Location Underground Servica 48 h�s. balore you Aig.TOLL FREE NUMBER 1•800•424•5555. � j <br /> S�"�v€�t' A.vO Lc�arF.c' SE.�v.cES .�za.e Tis�.s GVT q.tcT I <br /> T ,9c� �N.(7%9C(E..D /�a'o��'7 TNE h1F�in/S /.t/ �!'�V'rE/J .:� o <br /> �CC�n�G� Ti,�E �S� �q.fE`in��n,'�, <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEM1IENT OF CONDITIONS <br /> The undersig�ied owner/aOP�icent hereby agraes to hold and aeve herm- <br /> — — —� less the City of Everett Irom eny and eIl clalms lor damapes, costa <br /> �, p expenses, or causee ol ection Ihet may erisa because ol Inatellation <br /> -������ �J B7 _ end main�enenco of ihe improvement o�other rlght-ol•way use hereto <br /> Approved for Co atruction� , Date epplied lor and lurther egrees to remove same upon notice from the <br /> �� � City end to replace public property demeged Ihnreby. <br /> � i'[7't�G 'f�v�y O � /, y� J <br /> � <br /> FI SPECTION Dete � /�—�--�--�� 7 <br /> Appioved es Consiructed Signatura of Applicant Dato <br /> everett PUBLIC WqRK;i DEPARTMENT WORK AUTHORI2ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Strent 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFfER IS TO I <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION.TIiIS PERMIT MAY BE <br /> Phone: 259-l�815 CANCELLEO BY TIIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PRQJECT UVER 90 OAYS DURATION. <br />