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/),� '/ �/� «�4 <br /> DatB12i�L{G_LT +E PUOIic WOAa Permit• O��� <br /> / / AppliCation For eiey.oeo�.• <br /> PUBLIC WORKS PERMIT � P�blicWorksFas s — <br /> To��l Fee <br /> Less Appl.Fae�aiE S- <br /> �ance Due s �d�'�� <br /> Print or Type Only � ��,.,�Z2yo/3s3/ <br /> M <br /> ' f N <br /> �jq ,,` ..� -bio�+.w ThG L i g o 2-�8'�N-.c 1 �w..� 9 bo�G '.5?G-�-'43S <br /> Owner MaJmg Addiess Cdy �� �� Phoqel <br /> i � t � � � ,e � <br /> � � � <br /> AOPlicant Mailing Atldress City Zip Phone <br /> Describe Proposed Work SI'rL� �' S� .� <br /> � <br /> Project Adtlress(it known) � � <br /> AttaC�four(4)topie5 of plans for propo58d work•Draw to scale antl nOte the following as appiiCable: � <br /> • Property Lines • Centedine of sireet � <br /> • Outline and dimensions oi all existing and • Indicate North . <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exisiing and proposed utilities • Show measu�ements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calis for inapection shall be made 24 hrs.in advance•phone 259�8810. � <br /> 2.All work shall be performed in accortlence with thia permit and current City of Everett Design and Constructlon <br /> Standards and Specificationx <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEN 1•800�4245555. � <br /> c�! l�j��/-ov� <�v r����::.� .3v fi�. l.��c� O <br /> "�G V ��� „�li, a�o�.� �.G: .Sov�.�.� ,5.0 �,,Cc� Lc�. <br /> d �. <br /> s �.� c�:-� .s�� �� � �/ �;,e� . � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant�ereby aqrees to hold ana save�harm- <br /> less ihe Ciry of Everetl from any and all claims for damages, caxts, <br /> ��G�_ _ expenses, or causes of action that may ariae because of installation <br /> � �� �,r�c���� and maintenance of the improvement oi other rig�t-of-way use herete <br /> ��t-� ��� apPlied for and funher agrees to remove same upon notice from the <br /> Approved for Construction � a�e City d ro replace public property damagad Mereby. <br /> �--� ?-7°'? .. Z <br /> FINAL PNSP£CTION Date <br /> Approved as Constructed oi Applicant � e <br /> THOR12ED 8V THIS PERMIT MUST BE STARTED WI7HIN <br /> PUBIICWORK$DEPAR?W1ENT BO Y OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200Ceder9treet BE DILIGENTLY PURSU�ED TO COMPLE?ION.THIS PERMIT MAV BE <br /> EveretL WA 98201 r CANCELLED BY THE ClTV UPON ANV STOPPAGE OF WORK ON THiS <br /> Phone:259�8870 I PROJECT OVER 90 DAVS DURATION. <br /> \ <br /> �.- <br />