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oate��G�C?E P�e���Wo�:Pe,���, f3�—/Z _ <br /> F Application For eiep.Deo��• <br /> � PUBLIC WORKS PERMIT °°b�,°Wo�.F�e <br /> iMel Fee s <br /> Lee�ApO�Fee PeiC s <br /> Print or Type Only Belance Due s �� �o <br /> t�(aZQ I McCQin�y }�. 0, i3rx�737 Fde�-� l-� qg��-a3 �59_v9�s <br /> � Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Deacribe Proposed Work. �bitiS;.P/icT �/��.�i/_�Cr GUT" fJ/✓/J T/✓_f7aC L <br /> C�Jj C// ,B,�S/i✓- <br /> _ 'A ��) W <br /> Project Addrees(if known) �902 ��'��OLdiJ y �Q, �'` � <br /> AttaCh four(4)copies o1 plens for proposed wo�k- Draw�o scale and note the fol � � <br /> � Property Lines • Cen! / � <br /> • Outline and dimensions of all ezisting and • Indic O Q � � <br /> proposed structures on the lot • Sho� �`' <br /> • Ezisting and proposed utilities � Sho� � � � � r �L/' � <br /> � �j G <br /> DO NOT WRITc BELON'THIS /J� � O <br /> v /- <br /> PERMIT CONDITIONS Q S � <br /> �� —L/ <br /> 1. All calls tor inspection shall be made 24 hrs. in aAvance- Uhone 2 � � <br /> 2. All work shall be perlormed in accordance with this permit and cw � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLI F � <br /> y I STGLG �'�i�N6'dSiN T}/PE �A /Jc�.0 CiT�/ -ST�N���/%, <br /> � �f0� . //Z�iTH o�G SE.�E�dTo,e/G4S' %E'e p PF•C O <br /> C/TY �STdND.dC7� � �f/O. <br /> / � <br /> S fd.L'.!i�/G GdT /�.d viit/6� TU t�s'E. �' /� GLdSS �' � � <br /> �S�i�/a�:- oliE,e ��� C,e�.s.v�o -S'�t�iivci.v�r. �/� <br /> G�, �.4.e.f�.c/G ST,eG� /.t/ �.�fG F'Oir/T �f' T/�'C Ii <br /> BUi�pii,�� �/fcut.l� .��- lo�,/S�,e�v c_�E� CLoSE.� <br /> % Tyc� f3l��C iv�,✓�r /�' /�o Ss i6'�E' <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> iess lhe City of Everett from any and all claims lor damages, costs, <br /> ���/ � expenses, of CaUses ol aGtion �hat may afi5e teCause ot inslallation <br /> �!�� �J� and maintenance of the improvement or other righFohway use herelo <br /> �� �- � G applied for and lurthe� agrees to remove same upon notice Irom Ihe <br /> Appfoved fo Cg Iruction Date City and to replace public property damaged thereby. <br /> / <br /> . �,` (� <br /> FINAL INSPECTION Date <br /> Approved as Constructed � ture of Applicanl Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT ST BE STP.RTED WITHIN <br /> � 3200CedarSlreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA 98201 BE DILIGENTLY PURSUED TO COMPLEtION. THIS PERMIT MAV BE <br /> Phone: 259-8815 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />