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G � —� e -s <br /> Date S / B PUEIit WorFs Permit• 8B— ZZ(o <br /> ` Appiication For eiop.oenc+ <br /> PUBLIC VWORKS 4�ERMIT r�oimwo�ksFee <br /> fotel Fec S <br /> Loss ApD�Fee PaiE $ <br /> P!int or Type Only Ba�,��eo�9 S� GS�N�PG�. <br /> .�tE�T Kc� r�� r�o.� F'..,rnc.2��•... �..a � E., :r�i.N rr.-� c ) ,�S's• � �u <br /> Uwner - Mailing Address Cily / Zip Phone <br /> S'1-rz�.F_ ,lCCr T.v s�-0 .-.,� � AS /.l ;1 c,.�� <br /> Applicant hlailing Address City Zip Phone <br /> Describe Proposed Work _� F' ^7 z �F �C�J/? E�" d rJ AR✓t .�.£"n. ,�Q ..,, q � L ,q � �_.�- <br /> /� �tk.J �...r frr �L � ti op� ,_,,, l� v o [c .� �... C. G/✓e.�. Gfi../� <br /> �.�' .v c ,4' U.�./' i.. D .. .,. L �4 c c d s•4'o .. <br /> /•�. b�✓ d L�/I ...i.. ✓� �-�J.l^j J ..1.. � �.� �%4 i�i ...OiQ � <br /> � <br /> Project Address(if known) _ _ � <br /> Attach four(4)copies ot plans for proposed work• Draw to scale and note the tollowing as applicable: e <br /> • Properry Linr.s • Cenlerline of slreet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements � <br /> �— DO NGT VVqITE BELOW THIS LINE <br /> PERMIT COP•IDITIONS O <br /> 1.All cails for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be perfcumed in accordance with this permit and current City of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> � ��'��i a. W 1 !o� � B"3'1 C�> � /i U � � <br /> ���� � �� �� ,� ���. �.y� ° , � <br /> ���s���� � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIJIJS <br /> The undersigned owner/aUPlicanl heieby agrees�o hold 2nd save harm- <br /> less the Ciry ol Everett irom any and all claims for damages, cosis. <br /> � � expenses, or causes of aclion that may arise because of instaliation <br /> c 1 /a-,���j-i� 5��8 and maintenance of the improvemen� or other right-o4way use hereto <br /> ' .CL! applied lor and furiher agrees to remove same upon nolice irom ihe <br /> Approved for h tion Date City and to replace public property damaged thereby. <br /> / <br /> 7-/J-�` / <br /> FINAL INSPECTION Date ��—� ���--- 6�-J- y � <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKSDEPA4TMEN7 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 320oCedarStreet 180 DAYS OF DATE PERt�11T IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:25S•SB70 CAfJCELLED BY THE ClTY UPON ANY STOPPAGE OF WOriK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />