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3� .`�r,� �b S.V. '� � �' y ��' <br /> � . ,. .� ; ..� �y '���`'�� <br /> � 7 x - "a <br /> n � p <br /> ,f ' x� �'�� � ri��, �j s�� ,..t�`iEelrF . ... _. <br /> .w,, .� r �.ti .� <br /> - . - . <i. <br /> ��� <br /> r Date S Q� �' {J��^^ / <br /> Puelic Works PermA s ��. <br /> Application For 8iaq.Deoi. <br /> PUBLIC WORKS PERMIT PuUli�WorknFee <br /> Total Fee S ���_ <br /> Less Appl Feo PeiO � <br /> Print or Type Only ea�,��,o�, S ��— <br /> F��9�.�'9 f/���u� <br /> 1i�i4Tf/ic 's Fi��s'�C'/� �7�7 �'o�� �� �2�/7.53 <br /> Owner Mailing Address Gty � Zip Phone <br /> ��a87i <br /> Applicant MailingAddress ��� <br /> Y Z�P Phone <br /> Describe Proposed Work ��?�� C���7 �/ /� �jUIL.�Lc� �,�!�_ <br /> ��7"- � �'vG�,f/ �� <br /> Project Address(il known) � C�� � <br /> Alt2ch four(4)copies ol plans 1or proposed work- Drew to scale and note the tollowing as applicable: � <br /> e Property Lines • Centerline of street � <br /> . • Outline and dimensions of all exisling and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMI7 CONOITIONS O <br /> 1. All calls�or inspection shall be made 24 hrs. in ativance• phone 259-$815. <br /> 2. All work shall be performed in accmdance with this permil and cuneM Cily of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Und�rground Service 48 hre.before you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> � <br /> y �=�,� ,�-=-oz� _' .�=3�-�� O <br /> .7= �r,—,<<.�� �—.3 .�.�9.e�i�c sr.sz�c�s�. � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- � <br /> less �he City of Everett from any and all claims for damages, cosis, <br /> U ��j/a(,� expenses, m causes ol action that may erise because of installation <br /> J and maintenance of the improvement or other righPol-way use hereto <br /> �Pproved for Constructlon � Date applied for and further agrees to rem�ve same upon notice from Ihe <br /> f--> Ciry and to replace public roperry damaged Ihereby. <br /> ' ---�="���_ G- �-��s l� .� <br /> ='FINAL INSP[CTION Uate �- ; �(� � <br /> Approved a;Conslructea SignaWre of Applicant / / Data <br /> rvc�irit PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS�PER T MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireel 7p0 DAYS OF UATE PERM1IIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:250-8815 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br /> I <br />' � J <br /> , �,.::�.;... . . -. <br />� . , <br />, i.a � <br />