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i <br /> �,5 - i67 <br /> �� Puthc Wo��s vernit• �� <br /> B�Cp Deot• ' <br /> Application Por _ I, <br /> PUBUC WORKS PERMIT P��bcworksiee S ; <br /> Total Fee <br /> Ll6e ApD�F¢e oa�0 $ � <br /> ea�a�«o�� s fc0.li�. <br /> . rint or Type ONy <br /> � , � �� lN�l 25S-C�8'/� <br /> Owner Mailing Address City / Zip Phone � Wn2h <br /> � � ��C�a'"�er l,�U�. C' (�i .� r�Pr[�� 98`�DI !1.5� -�9s7 I <br /> Applicant Madmg Address Gty Zip Phone Z <br /> 0 <br /> (� «�. <br /> DescribeProposedWork ���^��� �� '< <' �� �i�" � ✓�otP SOrne- �"��w��" �'P�C � <br /> m <br /> �' <br /> .. .. <br /> � � <br /> W � -� <br /> �, _ <br /> `�fr b � m <br /> Prolect Addrr.ss�il known) � m o <br /> � n <br /> Attach four(4)copies oi plans tor proposed work� Draw to scale and note ihe following as applicable: � 0 3 <br /> • Property Lines • Centerline of clreet m <br /> • Outline and dimensions ol all exixting and • Indicate Norih = � <br /> proposed strur.tures on the Iot • Show any proposed grading changes m M <br /> • Ezisling and proposed utilities • Show measuremeMs /� o z <br /> W a —� <br /> DO NOT WRITE BELOW THIS LINE O r x <br /> -i N <br /> PEFMIT CONDITIONS � <br /> � <br /> 1. ASI calls for insnection shall ue made 24 hrs. in advance- phone 259•881 5. � � A <br /> � a <br /> 2. All work shall be perlormed in accordance wifh this permit and curren�City ol Everett Design and Consiruction � m <br /> Slandards and Specifications. _ <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•SS55. � m N <br /> or <br /> c� m <br /> ;r /'�LdtiTC.0 �1�EaS CAN �.�ni BE� To�GLL/ O m `� <br /> �l•/n�/�/dTGO, /14d�n/Td�.tl A Mi�t//•t�U� <br /> z c� <br /> � � m <br /> /�e.aN:i•r/ts A.�'f,q — 5 ' ct�.x f'E•e ATi�vls�F� n <br /> A <br /> S�ETCr�- y♦ � <br /> O -� <br /> _ <br /> a � <br /> N <br /> Z <br /> O <br /> --1 <br /> n <br /> m <br /> ACKNOWLEDGEME-NT OF CONDITIONS <br /> The undersigned owner/applicaN:iereby agrees to hold and save harm- <br /> less ihe City of Everett Irom any and all claims for damaues, costs. <br /> expenses, or causes ol action ihat may arise because of installation <br /> �� ' G 7 f�S and maintenance ol �he imProvemen� or other righl-ol-waY use hereto <br /> /�7ctiC7�� applied lor and turther agrees to remove same upon notice irom Ihe <br /> Approved fot Con uclion �a1e Gity and to replace public property damaged ihereby. � <br /> / /� <br /> ! /o �/� �Ztc�� ,� � -�_fa/ ��/D / �S <br /> L INSPECTION Date ❑��p <br /> Approved as Consiructed Signature of Applic 1 <br /> WORK AUTHORIZEO BY THIS PERNI? iv1U5T BE STARTED WITHIN <br /> everMt PU2LIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8815 pROJECT OVER 90 DAYS DURATION. <br />