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� <br /> ( <br /> r ----- --- �--------_ w <br /> Date�����y <br /> Publlc WorMa permll s ?6� _ <br /> Applicatfon For ema.neo�.• <br /> PUBLIC WORKS PERMIT PUOTotelFoaFee s — <br /> LB95 A00�Fea PeiC .S �y.4 <br /> Print or Type Only aam��a o�, s —��9.S/ <br /> �Q/D /N fULG T09_37� <br /> �i C�`(i �1�cJ /IJC . /0 6 o Z N�� 3STN Q� /��/LI�U)N0� �'Go33 �Z?-G76 / <br /> Owner Mailing Address City Zip Phone <br /> _ NA2�C�' �Sc!-1M�0� io33S iy/}/N ,p � � ('I�EVu�: 9d'�� Y �JJ- 97�0 <br /> . Applicent � Mailing Address City Zip Phone <br /> DescribeProposedWork v\�M4VC Cx�S1 �ti1 �- SC/�VJCC Sji7��� 0A/ r�}L'��,Illts <br /> _, _ �n�0 �oNST2�ci nrv�i ��iZv�ct s�/�r�onl �NO CONVrn//rj1� Cc` <br /> _ Si�R�' /NCLuO �,�� 3 -� ��oo� G/1�. � / - /Lc7c�o G��. �. G . <br /> __Si u Ac L ?� NK S � <br /> Pro�act Address(if known) _ .�GU I T�f(j/ZC,.��L^�/ (.cf�, ✓ � <br /> Attach tour(4) copies of plans for proposed work- Draw lo scale and note the lollaving as applica6le: <br /> Y Property Lines � <br /> • Centedine of street I_ <br /> • Outline and dimenslons of all existing and • Indicate Norih �+ <br /> � proposed struc:ures on;he lot • Show any proposed gradin9 chenges <br /> • Existing and Nroposed utilities • Show measurements <br /> DO �!OT WRITE BELOW THIS LINE � <br /> PERMIT COMDITIONS O <br /> 7. All calls for inspaction shall he made 24 hrs. in advance• phone 258-8II1 5. <br /> 2. All work shall be peAormed in acwrdance with ihis permit and current Cily of Everell Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. beforn you dig.7'OLL FREE NUfJIBER 1-800•424•5555. <br /> � % BE Go�t/ST.L'�i�TE� .4s PE� �CQ�vs � <br /> D/JrF�o �t.vo .4v�,e�ave�,� c.v y- i8 8re � <br /> ♦r^ <br /> V♦ <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to huld and save harm- <br /> less tho City of Everett from any and all claims for damages, wsts, <br /> /r� expen=,es, or cau;es al action that may arise because of installatlon <br /> �. �-�ag�1�?J�C�? �U`� �'SC and maintenance ot ihe im:rovement or other ria�hl•ol�waY use herelo <br /> Appt bed lor Construction ` � Date applied for and further agrees to remove same upon notice from iiie <br /> ��- � � City and to replace public pro rty damaged thereby. <br /> % '��/ .- 'L l�//-.2/- G ' � � f y��'/� ' <br /> , .fIKAL INSPECTION Date ---��- Y � <br /> � Approved as Cunstructed ignalure of k plicanlG Gale <br /> i <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 9Y THIS PERMIT MI�ST BE STAf;TED WITHIN <br /> ` � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO <br /> Ev?relt, WA 98201 BE DILIGENTLY PURSUED TO COMPLEI�ICN. THIS PERMIT MA1' BE <br /> Pfione: 259•8815 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 50 DAYS DURATION. ��� <br /> L -� <br /> �._ <br />