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Date./S2J.C�/�y vubtic Works Per • �� ��� <br /> ' Applicetion For eieo�oea+.o L _ <br /> PUBLIC WORKS PERMIT PubTOWFeeFee = � a. <br /> Las!�p0�Fee PeIG s <br /> Prir,t or Type Only Bele�eDue f <br /> �"s�9 ds1-'�a �3 <br /> ��ptP�'���PeJ J�Jn1He�-C No �ne �/��S L�j�e.dA�� ��`(— <br /> ^ Owner Mailing Address City Zip Phone <br /> �P�-� <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work � ��� � � <br /> � EXP.a.vO /��.C�.��?JG L O%. <br /> --• <br /> W <br /> Pro�ect Address(if known) � <br /> Attech four(4�copies of plans lor proposed work• Draw to scale and note th ollowing as applicable: � <br /> • Property Lines • Centerline o(street � <br /> � Oirtfine and dirr�ensions ol all existing and • Indicate North <br /> propcsed structures on the lot • Show any proposed grading changes <br /> � Existiny and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance• phone 259-881 5. � <br /> 2. All work sha�l be performed in accordance wilb this permil and current City of Everett Design and Construclion <br /> St�nderde end Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> y To BE Cc�t/ST2Uc7E.0 As PE.e Pc.aNs ,�f,o,Qovc'r� An/D � <br /> DATEA //- G -Bfc . O <br /> ii <br /> S Tf/E APf'Cicdti7 S,✓ac� Posr A 8o�+/D /ti Ti�E r�F..,�qG � <br /> Suin aF '�7000� N//TN/N i7aiCn/�-l/ 04s/S �4'qLE/vOE�� �/= THE � <br /> V�rE aF Na�:F.c.vT�oN By T.t/E ,BUf3L/C ��,e,cs LY,eFcro�� <br /> Q,p {�iS 1�ESiG.VEE .. . /15 PC.� SfEGi,cL ��'oPEQTfi CISE O <br /> f'�.�ir,�r i0'�z-83 co,vo�Xioz� �i9. 'L Fo,e Ploes.-,e.a�v vurywpf! Yr <br /> �. T//E GddTE,e ,l'jEPT /t�Aj/ ,��rqU/,e"� .A BAC,e�Lo�J �Ev/SE � DoU.�y[E' <br /> .�Er��ro,e Gyec.� qssEMr3c�v PE,e c.ry STA,�vA.eOs onr FxisT.ti�r <br /> LUrAT�it' SE�f�/L(>� qCKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everetl Irom any and all claims lor damages, costs, <br /> .� ,/ ezpenses, or causes ol aclion that may arise because of instaltation <br /> C�X� - /l _,G? OQ� / � ,� � and maintensnce ot Ihe improvement or other right-of•way use hereto <br /> /..JrfNu I��o-a� applied tor and further agrees to move same upon no;ice Irom the <br /> Approved for Co str ct n ate City and t lace public prop � damaged thereby. <br /> � <br /> �� 8 / � ,�. <br /> � i_ 6 - � <br /> FINAL INSPECTION Oate <br /> Approv^d as Constructed Signature of Applicant Dete <br /> everett PUBLIC WORKS UEPARTMENT WOtiK AUTHORIZED BY T4115 PERMIT MUST BE STARTED WITHIN � <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> BE DILIGENTLY PURgUED TO COMPLETION. THIS PERMIT MAY LE <br /> Everett,W.4 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Fhone: 259-8815 PROJECT OVER 90 DAY° DURATION. <br />