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Date���� _ ; �,:— ;�� �:i��� � <br /> f' G�',u � PUEI¢\4orks Permii• —� <br /> Applicalion For e�op.oaoi.• <br /> � �-- a <br /> PUBLIC WORKS PERMIT P°°:;aFeeFee s — <br /> Less Aoo�.Fee Paie $ <br /> Print or Type Only ea�r�«o�� S �3 6s <br /> �� �/ / / � i <br /> G�r �w f t (Scr /�.i5��1� 1�(OaGf.�/u .C�/rJ�'� Gk.?Q� 75 r1 ..Z3 !J <br /> Owner Mailing Address City Zip Phone <br /> •'/ � ��+ 'eISPH //� SNh� k�i� i ��.cec� 9br,7v� a�-s. �� <br /> Applicant Mailing Addmss Cdy Zip Phone <br /> Describe Proposed Work �d�.�J"i e n d � � , do � �d � 'fa E.��—�—� �-- <br /> �����'r tn_/O / ✓ObJsf � �AC-�c 'P .n frY_ �.�J � /[5f�,✓ <br /> �d �T�T/✓_,p�f�/� o S ri rl 57�� <br /> W <br /> Project Address(II known) . �' � <br /> Attach four(4)copies of plans lor proposed work- Draw to scale and note the lollowing as applica6le: � <br /> • Proporty Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing end proposed utilities • Show measurements � <br /> DO NOT WRITF BELOW THiS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance��hone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Speciticstluns. <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> !; cSlTE' lc:b,E'.0 ?O 6'E �c7.C/E �c� A.�i�.��uEO O <br /> PCQ.vS l�e�-p i 8-B6_ <br /> � vGTG/i� G-�LS'//!�S A.f'E TO ,[j�C C[7NNEGT�IJ �/f�-ST.PE�1y/ H <br /> UF TNE SioESEwE.�_ � <br /> lp. .S'iOc�SF4/E.0 /r�lvsi^ 8E lo �� 1�/amETE.e F,AOM T.s�E O <br /> au,.ca..dG 7o r� s':��ehia„�/. <br /> �- � �� (� lo, �� �� ������ a <br /> P �� �� ��� ��/ � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> �G��� The undersigned owner/applicant hereby agmes to hold and save harm• <br /> less the Cily ol Everetl Irom any and all claims lor damages, costs, <br /> expenses, or caoses of action lhat may arise because ol installation <br /> �����j�,y � !�_�� and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved f Construclion /� Date <br /> City and to replace p�blic property dama9ed thereby. <br /> �/�� �l%��. <br /> ��1�� ��-� �- � 7-`F7 �� J-3-r5'G <br /> FINA INSPECTION Date <br /> Approved as Construc�ed Signatur ' f Applicant Oate <br /> everett PUBLIC WORKS DEPARTMENT WOR AU7HORIZED 8Y THIS PERAIIT MUST BE STARTEJ WITHIN <br /> � 3200CedarStreet �ti0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•8875 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEC7 OVEF 90 DAYS DURATION. <br />