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/ <br /> Date�o �'�� /+:-3) „�„ Puonc Worhs Permit s _ <br /> ApplicationFor E�Ep.DeO��• `>������'r� <br /> PUBLIG WORkS PERMIT °°°��°w°�•=`eO — <br /> iotalFee S-- <br /> Lev AopL Fee PaiE $_ <br /> y�y eaiance Due 5 <br /> w� Print or Type Only <br /> >H <br /> �C,�H � • <br /> a H Cn //�.c�c.'.c� �,ec2Gzinc.,r.,.J <br /> y �H Owner Mailing Address City Zip Phone <br /> � �-7� � � �r 7 .�_._ o .�. � / <br /> 1p (��AH tirr..���• � .% O --4ti /S'"�,i._ �._.C-«-c_/_-../�..�c. .�:...� �1'J!(/�'-',cr-,.� �j ,F2.7:� ���r- 9.��5_'S' <br /> Applicanl Mailing Address City Zia Phone <br /> � x <br /> y d Describe Proposed Wurk �' � <br /> OH <br /> H/� ng <br /> y�V C] <br /> z �r� � - — �i <br /> Ez <br /> � �y Prolect Address(il known) S�6 S� �Y �. •:�-� •=.�. � ���`—� � � <br /> H � <br /> n d p� Atlach four(4)copies of plans lor proposed work• Draw to Scale and note the followmg as applicable: � <br /> � �t-i • Property Lines • Cenlerline ot street /f <br /> t�J • Outline and dimensions of all existing and s Indicale North V� <br /> yp� proposed structures on Ihe lol e Show any proposed grading changes � <br /> _ _ • Existing and proposed utilities • Show measuremenls � <br /> ���-OT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIO�S <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> � 2.All work shall be pedormed in accordance with this permil antl current City of Everett Design anC Construction E <br /> Star.dards and Specilications. <br /> i�� 3.Call Location Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER"1•800-424•5555. � <br /> +' , <br /> ���� �J��G Lc.%c>% li��,.._- ito ,(:� .c<r, �' � <br /> �� �- �- _ , , � <br /> �-� ;�'�_ „ �f, <br /> i„{�Q � <br /> � <br /> rm <br /> .R._�,;� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underaigned owner/applicanl herehy agrees to hold and save harm� <br /> � less the City ol Everelt Irom any and all claims lor damages, costs. <br /> �,� eapenses, or causes of action that may arise because ol installatior. <br /> and mainlenance ol the improvement or other righFol-way use hereto <br /> applied lor and lurlher agrees to remove same upon nolice Irom the <br /> Approved lor Consiruction Date City and to replace public propeny damaged ihere6y. <br /> FINAL INSPEC��ION Dale <br /> Approved as Constructed Signalure of Applicant Dale <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> �� 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> � Everett,WA98201 BE DILIGENTLY PURSUEO TO COMPLETICIN.THIS PERMIT MAV BE <br /> Phono:259�8810 ��NCELLED BY THE CITY UPON NNY STOPPAGE OF WORK ON THIS <br /> PqOJECT OVEfl 90 DAYS DURATIUIJ. <br /> � <br />