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�8te vumk works Perm�t. � `" G� <br />. BiaO�Oeo1.• <br /> Application Por <br /> PUBLIC WORKS PERMIT P°°To,:F�s"° • <br /> lee�Appl.Fee PaiE S <br /> e�ientt Due S 9d.0d <br /> Print or Type Only � �-� �r J <br /> 7'ZS� <br /> ("�,-yz� rr'SUS (.�//9�tUr� �,,vuit/'l. L/� Z.�,L- 7L73 i <br /> �O^W e a�1� Mailin Address Cdy � Zip�—T Phone <br /> Applicant <br /> • Mailing Address City 2ip Phone <br /> Describe Propos d Work � , � • '� <br /> I � , B.rsi � • �� <br /> � � " — /OOa� �sf , <br /> W ' <br /> . ' <br /> Pro�ect Address(if known) � <br /> � <br /> Attach(our(4�copies of p�ans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and � Indicate North <br /> proposed structures on the lot � • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calis lor inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> :i Call Location Underground Service 48 hrs. before you dig.TOIL FREE NUMBER 1-500•424•5555. � <br /> 5! /�7ErHnos aF ��.�pSioN .t�v� SEo/mE'�/7'.oTioN O <br /> Coiv.-�'-oL SNdtG ,8E DETOiZn7ENE� �y r'rF <br /> BUb'L iC GIJa K�s iNs"�'EcTiae . �. <br /> � <br /> O <br /> a <br /> ACKN0IM1'LEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and suve herm- <br /> less Ihe City ol Eoerett Irom any and all claims tor damages, costs, <br /> expenses, or causes ot action thal niay arise because o� installation <br /> , � � /�' /G�j4 and maintenance ol the improvenent or olher righhot•way use hereto <br /> e�o'�"� applied for and further agrees to remove same upon notice from the <br /> Approvetl for Concl s ion ��e City and to replace public nroperry ma ed thereby. <br /> -�..F��� /�r,� r�� '` �-� � 7 � � <br /> FINAL �NSPEC�710N -`]�\ \ Oate t" <br /> Approved as Construcled I\ � Signature of Applicant Uete <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE SIARTED WITHIN <br /> everett PUBLIC YJORKS DFPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DIUGENTI'f PURSUED TO COMPLETION.TNIS PERMIT R1.4V BE <br /> Everett.WA 98201 CANCELL[0 BY THE CITY UPON ANY STOPPAGE OF WORK ON'HI5 <br /> Phone: 259•8875 PROJECT QVER 90 DAYS DURATION. <br />