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� <br /> c' '�) <br /> �8�e "/r - ..– .__– '_'_—_"–___ –_.". Pu011<WorbPermits `�/ 2� I <br /> Aoplicatlon For ama.oeo�• <br /> PUBLIC WORKS PERMlT �e;a,Wo�eFee s , <br /> Leu ApOI Fs!P��E a ' <br /> 8����ceDue a �Q'�n <br /> Print or Type Only G 77�0 � <br /> r�sc Z�' <br /> Owner Malling Addre6s City Zip Phone <br /> .y..�"/�, �i� S.n C/r.i/t .Y6o9 Ce��v /0/t' E'vi.te�' 9�720� �.i�— �cgn� <br /> Applicant � Mailing Address City 2ip Phone <br /> Describe Proposed Work _, C�Nan 6ni �C �c.+.�' on STdRFFA�ddi / �w�y <br /> �� s� ��l s�e,�� �.CONr . «.�k <br /> Ji, " Yf4CI) ' G�' L�i-t� +/ I'lC' <br /> W <br /> Project Address Ot known) � <br /> Aftach four(4)copies of plans for proposed work- Draw to scale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline end dimensions ol all existing end • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hra in advance- phc�e 259-8815. � <br /> 2. All work shal�be peAormed in acwrdance wdh Ihis permit anc current City ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Loca!ion Underground Servlce 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> '-lJw�� ��b�'U"tV Tv""� �1�= l�� � <br /> �1-�c=� ��-,. `�� Cb�-�.�P��-�'-� p��wmES . !" <br /> � <br /> � <br /> a <br /> i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees fo hoid and save harm� <br /> less the City of Everett from any and all claims lor dama�es, cosls, <br /> exFenses, or causes uf action that may arise because ol installation <br /> ,�y�U� .�f',. "'�-,� � ���-�{. and maintenanCe ol ihe improvement or other right-oi-way use hereto <br /> �_• a•B�G �� � applied lor and further ayrees to remove same upon notice irom the <br /> Approved for Construction Date Cily and to replace public property damaged thereby. <br /> �_✓� �l� �-/� �y . . � <br /> � FINAL INSPECTION Date � <br /> Approved es Constructed Si �ure o Applicant �e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PE9MIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 1B0 DAYS OF DATE PERMIT IS ISSUED AND T7iEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259-BB15 CANCELLED BY�THE�.�ITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER,f0 DAYS DURATION. <br /> � <br /> i ' <br /> � <br />