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Date�:Z/'� oublic Work�Permll s v � 4J � <br /> / Application For eieo.oso�.�_ t���/S��/S< <br /> PUBLIC WORKS PERIIAIT P°°��°W°��•FB° <br /> ,o�.�Fee s <br /> Leu AppL Fea PeiC S <br /> Print or Type Only BelanceDue S a�7.F>D <br /> 79�2 9G <br /> j,4v�.v A, d.�'�.�/o,��nc�7 i,'a �'nx 820 �•�E.P�',T l,d,-f_ .3S5-6o�/ <br /> Owner Mailing Address Cily Zip ' Phone <br /> ✓iirJ �Air�/� 207- icf'8 t�iVG✓, .Q.C'GiNG.�J/✓ /052-�'2.35� <br /> Applicant Mailing Address City 2ip Phone <br /> Describe Proposed Work L U�ST�PuGT SinJGLE .f4��7iaY .C�ES���Ei.vGE- <br /> i <br /> -- � <br /> Pro�ect Addross(if known) J i��2'" 6'�'G'an:.��l � � <br /> / <br /> Attach lour(4? copies of plans for proposed work- Draw to scale and note lhe following as applicable: � <br /> • P�operty Lines • Centerline of street � <br /> • Uutline and dimensions of all existing and • Indicate Norih <br /> nrp�:��sed structures on the lot • Show any proposed greding changes <br /> • E��s�Iny and proposed utilities • Show measurements � <br /> DO NOT WFiITE BELOW THIS LINE O <br /> PERMIT CONOITIONS <br /> t. All calt:�for inspection shell be made 24 hrs. in advance- phone 259•�881 5. � <br /> 2. All w.ork shall be performed in accordance with this permit and current City of Everett Design ar�d Construction <br /> Standards and Specifications. <br /> 3. Call location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424�•5555. � <br /> y P��E 0,��✓C��J.e/ APP.eoQa,�/ Sc TH�%GKd✓E-G <br /> /S.✓T �'ic.tE� OUT ONTo B.eod D�vp f/ d f/ O <br /> YEN�LC'cc'S GO/.cJb r,�P �����Ei�t/A�/, � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry ot Eveietl from any and all claims for damages, cosis, <br /> � / expenses, or causes ol aclion lhat may arise because o( inslallalion <br /> �f%'. / ,Q,� � 9_�S and maintenance of the improvement or other righl-o4way use hereto <br /> l�vGv•v� applied lor and lurther agrees to remove same upon notice irom the <br /> Approved for ConS ruction Date City and to replace public property dar�agetl ihereby. <br /> ���y8�r <br /> FINAL INSP ION Date � � �+ � l�� �s/gs <br /> Approved as ConsVucted Sighature of Applicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED E3Y THIS PERMIT MUST BE STARTED INITHIN <br /> � 32GOCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98207 BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 2b9•8815 CANCELLED BY THE CI7Y UPON ANY S70PPAGE OF WORK ON THIS <br /> PROJECT OVER SO �AYS DUFATION. <br />