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r ., <br /> � <br /> Date 5 5 83 83 10 <br /> Public Worke Permif s <br /> Application For eiea�oev�. <br /> Pl�E3Llt: WORKS PERMIT PuEi¢WorkaFee o� <br /> Tolel Fee S �O <br /> � Less ADD�.Fee PaiE S � <br /> + Print or Type Oniy ea�a��ao�a S-a O�= <br /> Ga �y <br /> ar�a .. 13uc�+ e� � 219 P�rua�w.. E.. {- 9F�.oi a2s9-O/ :> S <br /> Owner Mailing Address City Zip Phone <br /> 5 a.-� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _C3_�-� -�v c„ cra�.vt s�{r ;- � <br /> Project Address(if known) ��-�`1 .-o...51,,...n � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Properry Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed arading changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW 1�HIS IINE <br /> PERMIT CONDITIONS O <br /> 1. All calls tor inspection shall be made 24 hrs. in advcaca� ^hone 259•88�5. � <br /> 2. All work shall be performed in accordance with this perm�;and current City of Everetl Design and Construction ' <br /> Standards and Specifications. <br /> 3. Call Location Undergrouno Service 48 hrs.before you dig.TOLL FHEE NUMBER 1•800-424•5555. � <br /> � <br /> , �..n�.-w��-• ct S w���� � a..�s�.LP � � la..,�er <br /> a�roso �w...� o} n Y-o n e.�'�� � ,.J� � �o..-�K- O <br /> (/' 1 1 � 1 1 1 '�d�a'e� <br /> pT L' FaYt�.�` �^�l� S.el QwR�1C� • PIA..�`� 1 h C 9 G.fC �U � <br /> ( J (� � 1 <br /> ,ot o�1 2 �cfeGv. ..n� '�'��e o.,...Y n.�c sp �i� � <br /> [i w.�.n . w.tiv-� � !' 3�ca„ N��� � � 'AW'(' lN ` O I <br /> C! <br /> r � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett Irom any and all claims for damages, costs, � <br /> � expenses, or causes of action that may arise beceuse of installation � <br /> S�_� and mainlenance of ihe improvement or othe� right-of-way use hereto <br /> applied tor and furlher a rees to remove same u on notice from the � <br /> Approved for iruclio Date 9 P <br /> Cit nd t r public propeft damaged t ereby. <br /> � � I'�G - /� . ��� <br /> FINAL INSPECTION Date � i <br /> Approved as Consiructed Signature o� p ican Date <br /> everett PUBLIC WORKS DEPARTMENT �'�'f�RK AUTHORI2ED BY THIS PERMIT IdUST BE STARTED WITHIN I <br /> 3200 Cedar Slreet u-8o DAYS OF DATE PERMIT IS ISSUED AIJD THEFEAFTER IS TO <br /> � Everett,WA 98201 BE DILIGENT�Y PUf7SUED TO COMPLETION. THIS PERMIT MAY BE � <br /> Phone: 259-8815 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> L PFOJECT OVER 90 DAYS DUFATION. <br /> . � <br />