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Date ^-+" 1 � PUEIitWorkSPermit+ ✓ / ��� <br /> Application For eiae�oea�., <br /> PUBLIC WORKS PERMIT P�b,,�We�k,Feo <br /> tolal Fee 5 <br /> ���/�1 n��� LeiaRDD�FeePaiC S <br /> � ao— <br /> Print or Type Only �� ~ Balance0ue $ <br /> a <br /> �O�)L L. S�vy�2TL- /S��GRCAr,hrsa�- �:-L;a,,,i-r IirA D/ �5i') ��s'7�— I <br /> Owner Maihng Address Cit <br /> Y ZiP Phone <br /> -��� As /3-6oc-' <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work Co�-rno� f�- ��/If-��u= W/1ZYL ' � C��V/}TL $�pL (ry �./LO•�+'O <br /> �~— <br /> $�1a^�7�n'!� Ot�ODN=�, d (NL� L�SGMN+'i �7/1LL T"Pc/� �� C/�T)!&'/JPV N /a.,itiw»�. �[av.vEti�o i✓.}N i4 ` <br /> P✓� A Er�s;,,ve- S';%c,,, /�:��� sv ne..c� l,w�-�v;n — Q�, �ri� <br /> �,o,•, f/a>�.ha=nzr�c w,u.Gc <br /> �7//7M.W,N:O lY�ir/! Miv pi TvW 4 � �:. ��'/I�j ? i Q �NGiy� 1AI>1/ V yt.•ya � <br /> W02Y. ?0 (>< 'iYl'.rd���� I" - tire S n/� •� r^ :.�✓�ztt .vc. <br /> Projecl Address(if known) ' O �.n4 vu�('r!T wrr y-.>�r � <br /> Attach lour(4)copies of plans for proposed work•Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ot sireel � <br /> • Outline and dimensions of all eaisting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance•phone 259-8815. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs.before you tl�g.TOLL FREE NUMBER 1•800-424•5555. <br /> 7 %o d'� C�.vSr,e�cT.�O /��'.P �i<'s��<bv� c$'/fErCf/ � <br /> �Ar�v �i-iy-s� O <br /> � <br /> � <br /> � <br /> a <br /> ACICNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed owneqapplicant hereby agrees to hold and save harm- <br /> less the Ciry of Everetl Irom any and all claims lor damages, costs, <br /> �' //g� expenses, or causes of action that may arise because of insta�latlon <br /> �,�/f,�-�pp/3� �� 9 and maintenance of the improvement or other righFol-way use hereto <br /> Approved for Consir� �� applied for and turther agrees to remove same upon notice fram the <br /> City and to replace public property damaged thereby. <br /> /�-�-6� �,7rtf /� /�+,�`� 11-/C' � 7 <br /> FINAL INSPECTION T— <br /> I Approved as Constructed Signature of Applicant Date <br />� everett PUBLIC WOFY,S DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8E STAFTEII WITHIN <br /> � 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUEU AND THEFiEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />