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�-�- Appl¢ation For //�� �� <br /> PUBLiC V�i'ORKS PERMIT °a�e <br /> � PU@LIC WORKS DEPAR7 MENT Public Works Pertni;N 5-3�8D <br /> �AN 2 � � =- 3200 Cedar Stmet <br /> ��i ?OSTCNG _--- Ever`Ctt.WA98207 259-881U BuildingPermitp � <br /> � ; ; <br /> rr� r'i r_. i� c� r.: ri �. <br /> t:� In ti r i O . i r) i'� <br /> IYPE OR PRINT ONLY �:_ n r; r_n �,=, �': .i Public Works Fee$ SS� _ <br /> c, �;; ic r- r� . o, <br /> : , <br /> c- :.� ei ��o �t <br /> �Rr�M�►J �Ae� r1� �. =' s�2.$ ��s��/4��Mi�� �cmcy'�' w►A `��c 33�'-�(a�n <br /> Owner Malling ddress� �� o: n :� �•Cit� :- Zip PhoneCa�� '�tjtf.� 'jb� <br /> �� (s: O C: F: (c� r.l G1 ' 3 ) <br /> S �� �O O [� :I- O W Ci I�� - W G > I i i !3 <br /> � n � C•� �,I O 1- C� 3 p �'� CJ H J. I.�_� <br /> \ r1 .I . f.l Q O V.I b G3 G fs: 1- .+ <br /> f.l '�'� (i. fJt 1.. :S S. flY V (. �Y (i Cl (.l <br /> Applicunt Mailing Address City Zip Phone <br /> Describe Proposed Work N'�� P����J�L G L� % TC� I�f�—� (3C[/,C�ln/� � <br /> r <br /> � <br /> V♦ <br /> PROJECTADDRESS(if known) 372 (v — COL b � <br /> Attach(our(4)copies ot plans for proposed work-Drew to scale and note the tollowing if applicablo: <br /> •Property Lines �'Outline and dimensions of all rxisting and proposed siructures on the lot •Existing and pr000setl uiilities O <br /> •Centedine of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call I_ocation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. H <br /> —�—� r L //� <br /> • ///�.1'�'/1>Jc•G/ /Z• U//�S '�ic /r+5�6�Cafiri� oi� Vj <br /> Gv�� �r.:I�t���-.�n� O/� <br /> �'. C'/!r%L Cc/U�,c� fo �c cs!,ne f7er� n,�pl�:✓c � ii <br /> �w4��s �t��d ii .�z-�b �sC�� 6���Cd.�.� d�p-t <br /> PLO.15 '1'or' jJWhhin� q��,t,Ocia� �Cof+/ 4►/r.c�C�� <br /> r ACKNOWLEDGEMENT OF CONDI110NS <br /> `/_ � The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> �( �� �Z^p_9L the City oF Everett from any and all claims for damages,costs,expenses,or <br /> Ap�oved for on� c Date causes of action that may a�ise because of installation and maintenance of <br /> � ihe improvement or other nght-of-way use hereto applied 1or and further agmes <br /> to remove same upon notice from the Cily and to replace public propeity <br /> c7 damaged ihereby. <br /> FIN�A INSPECTI N �Dat� / / <br /> ' Approved as ConSructed -�� / �/Z6./Q�. <br /> Signatu�t Applica� Date <br /> ItiORK AUTHORIZED BV TNIS PEFMIT MUST BE STARTED WITHIN 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIL�GENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT�AAY�F CANCELLE�BY 7NE CITY UPON ANY STOPPA6E OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />