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...._.. . . .. .pa?'Au�i�r�ww✓ii":�%wrh�M'^+...,....,R. . ... _. ,.. ... , - <br /> � . �.t�. ._ ;n- . � . - .._...�... .�....�-...- ... .. . _.� <br /> rs <br /> J Q;,� '- <br /> Date � �`�J <br /> Pu�lq Wprkv PermH• <br /> Applica�ion Fol .j,, Bme �eoi.� <br /> PUBUC WORKS PERMlT PotiLCWorx�Fee /�i� � <br /> Totai Fec s— 7� % �� <br /> _� LnSSAnui FeePeio s. <br /> Print or Type Only �_ � � a,�,�,�o�� s �,S`� � <br /> -s o' � <br /> �'i �: �: � <br /> .-� - ! <br /> ,, w .,� <br /> _I d/�AV!✓ /�f'vi /: ,..� �,v� �.? h' l�}Tya/.. �. . . . . , - . � <br /> Owner MailingAdtlre}55� f� r� �� �_ Ci�y Zin ,�/ � Phone � <br /> �_i <br /> . , .. �i/ ✓//•'.._./� r . < _.1 '. _ _. � <br /> Applicant Mailinq Address Cily Zip Phone <br /> �> ,s <br /> DeSCribe PrOpOSed WOrk ' �- '' �`/ ✓�l�� � ti 1�„ �,. a /-' �j L"� o ��� i, . �, � i, <br /> %- �.,,,. � /:-. � T - � % ! r - 4'„r <br /> Projec�Add�ess pl known) �'�+� �� ��':! ✓' �//,� � � � <br /> � — �M1 I LC•9/ � <br /> Allach four 14)conies of plans lor proposed work Uraw lo scale and note the following as applicable� � <br /> • Property Lines • Centorline of street � <br /> � Oulline and dimensions oi all exisling and • Indicate Norih <br /> proposed slru[tures on ihe lol • Show:ny proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT V/RITE BELOW TIi15lINF � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance with this permit and cmrent City of Everett Design and Construction ' <br /> Slanderds and Speci(ications. <br /> 3.Cail Lo:ation Underground Se rvicr,a8 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> � � <br /> ��, fi..�!'/_� {"� Y ! �� . - Y O <br /> � �fr-!1/=� C�fG 1 C , /j!� i%/)�F� <br /> � n � � <br /> ,� !%.('n� C� . � c...-f'�. / r ' � <br /> - �/:,' " ��,�-i.� .J <br /> � <br /> O <br /> a <br /> ACKNOWL[DGEMENT OF CONDITIONS <br /> The undersigned owner/apphcanl hereby agrees fo hold antl save harm,- <br /> . - less the City ol Everell Irom any and all claims br damages, costs, <br /> -'�—� ���L��.'� ezpenses, or causes ol action ihat may arise because of installa�ion <br /> . . _ :-�� ��. �� and mainfenance of ihe imorovemenl or o�her nghl-obway use herelo <br /> - ' f� 'f�� applied lor and lurlhe� a rees to remove same upcn notice Irom Ihe <br /> Apprbved torCons� ction Date 9 <br /> . , City and lo replace public prnperty damaged thereby. <br /> i <br /> FINAL INSPECTION py1e �— '�' �_ � —f=�' <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEF1d1T MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br /> Everet(,WA98201 bE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAY BE <br /> Phone:259-8810 CANCELLED BY THE CRV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS DUF;ATION. <br />