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� <br /> r � <br /> . <br /> i,+/� .�U � Publ¢Warks Permil� �.jJ S� <br /> Appl:cation For ema.oev�-• <br /> PUBLIC WURKS PERMIT F P�°T;,;fBeF�� s /P�� �-c <br /> Pti�" ��Q/�_O' Lesa/.DDt Fee PeiE S{`.—' • wt <br /> YtN�/ Belence Due S�SQ�-��� <br /> Print or Type Only � su/,3�y_ ��3 /G�� <br /> �1 <br /> / .�iJ�rf'— �07/7 1/�z�u � G=�/��'�-�.�—`'� ����✓3 <br /> Owner Mailing Addre City Zip Phone <br /> �L. <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ����EyGLCf!'_ , �� C��Z�� U.� /���7 <br /> C/�/iCOf'"%t'AGi/C C / <br /> C:���� � W <br /> �� '_ <br /> Project Address(il known) _ �'��`' - � ��k�'�d�'��'� Q – � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � I <br /> • Property Lines • CentErline oi street ♦A <br /> • Outline and dimen,ions ol all existing and • Indicate NorBi V� <br /> proposed siructures on the lot • Show any proposed grading chanqes <br /> • Existing and proposed u�ilities • Show measurements � <br /> DO NOT WRITE BFLOW THIS LINE O <br /> PERMIT CONDITIC�NS <br /> 1. All calls tor inspection shall ne made 24 hrs. in advance- nhone 259•881 5. � <br /> 2. All work shall be perlormed in accordance wilh ihis permit and current City of Everett Design and Construc0on <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TO�L FREE NUMBER 1-800•424-5555. � <br /> S/. T �� Cv.risr.��vc:z=.a As f�c.e t'�v.�/ O <br /> /�iJ,Pv��E/� i4ti� .�'aTE.c'7 /1/?a/SfG <br /> 5 C�kA��/ A�c Ey P,a���NG- To c.a .—c.�i t�.�;.s /.c/ r <br /> i � <br /> � Tiyt� ii/UiZT/! U/L T/r'F G�cJE.sT Si.OG�df�',t'o4,�/�y <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/appliCant hereby agn;es lo hold and save harm- <br /> Iess the Cily of Everett irom any and all claims for damage>, costs, <br /> expenses, or causes of action ihat may a�ise because of installa�ion <br /> �- � _ /1 �.��D�,J and mainlenance ol �he improvr,ment or other right-of�way use herelo <br /> C�a��3z'� 'S�� �" applied for and turlher agrees to remove same upor nOtice irom ihe <br /> Approved IGr Cons ction ate City and to repiace public n�operty damaged ihereby. w <br /> �� `` f��65 � <br /> ' i�i/>,.��'�i' <br /> FINAL INSPECTION Date � - <br /> Approved as Consiructed Signalure oi Applicant �Dale <br /> evemtt PUBLIC WORKS DEPARTME T WORK AUTHORIZED BV THIS PERM1IIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DA7E PE-RMIT IS ISSUED AND TNEREAFTER IS TO <br /> � 3200 Cedar Slreet 9E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett.lNA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phonc: 259�8815 PROJECT OVER 90 DAYS DURATION. "'' <br />