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� <br /> / <br /> � <br /> 2 /// yj PUDI¢Works Purmil r �—� � <br /> Date '� 9 i <br /> DinO.Dept' <br /> ApPlicatjef For <br /> PUBLIC WOF�(S PERMIT P°°1oWF�o`°a 5 — <br /> 0 Less nna�.Fec Pa�J $ <br /> O 0 Q �alance Dun � ��� <br /> Print or Type Only a � � �JD�—.���Z-5'O-ODO�//-B3( <br /> � o0 <br /> � � � � 9 � ,��,�{���c fL-. P le v° 9P�JDs y.r�-/6o0 <br /> � . ��� <br /> Owner Ma�Tg�AB��� y. Ctly Zip Phone <br /> ,��, oor- w <br /> � v�'� �e��r M ,. � � o � � - � � � . <br /> Applicant Mailing Address City ZiP Phone <br /> Describe Proposed Work /� <br /> — — ;' � o% c � C✓� CJ�1 �.( ,. /'� � �. <br /> ./-� I� I ti 1� AG ^In lC C� � \ <br /> c� � � ,— �- � T `" � — .� <br /> � ' W,� -�c c— e� �' �r :. � c�i i ia: -/-',� c ' a � � <br /> Prolect Address lif known) r !' e r' n G r J f S N N � L�Y 'U rC-� G'�� � ~ <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note ihe tollowing as applicable: � <br /> • property Lines • Centerline of sireet � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed structures onthelot • Show any proposetl grading changes <br /> • Ezisting and pwposed Wilities • Show measurements � <br /> � DU NOT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> 1.All oalls for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � �fTL� �O .�L L•d7w� �j4-../e. ��'�C�v`�A� �Gzsu� O <br />� �Ri�t� 3—.��� � <br /> � <br /> O <br /> a <br /> ACKNOWL'EDGEMENT OF CONDITIONS <br /> 7he undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett irom any and all claims tor damages, costs. <br /> expenses, or causes o( action that may arise because of installation <br /> � / Q�� ,/q �,o and maintenance of the improvement or other right-of-way use hereto <br /> �F ��� � -S // ? applied tor and further agrees to remove same upon notice from the � <br /> Approv or C nstruction Date Ciry and to replace public property damaged thereby. I <br /> �.G�t �O � .�./���o ce �vc u-��� ((co� .Z�IY/.P9 <br /> FINAL INSPECTIOI G � ta ure of Applicant �a1e �' <br /> Approved as Constructed <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DIIIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evere!t,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br /> �' <br /> i <br /> i <br /> I <br />