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_ .:_ __,_,-___, __ ___. <br /> Date�� 9 / % <br /> PUEIic Wo�ks Parmi�♦ �/ fp '�__ <br /> ApplicationFor Tp pOSTING Z_ B��B-Daytu aa <br /> PUBLIC WORKS PERMI PubhcWorwsFee -� <br /> TotalFee S_-- �i9 _ <br /> less nnpi Fae Paio S � <br /> Print or Type Oniv Balance Due s l� � <br /> �lar,rd/h .�1�/VC. M/ /D �ir�� h(n�.n *�lJ.�n' .C�ul��.e Q /� ✓P/p71��a�9 o��(F a <br /> Owner Maihng Address Cit <br /> Y Zip Phone <br /> �%illvl d-�Ar�� / �-1� t1LSdJ-L7!!Q � ���.X�IJ�/.Q I+i !�p�r <br /> Applicant Mailing Address ��'��� ya V 46 ���-aa �p <br /> p Phone <br /> Describe Proposed Work i .��-��� �JQ�p n �nn /n � � <br /> .�L S E/'-�—� _ <br /> ' Project Address(if known �LDG�B� y�//fi7S�l � <br /> � , _/072/ - Ei/F.PG{'cEn! W � <br /> Attach fo�r(4)copies of plans for proposed wo�k- Dr:iw to scale and note the following as applicable: <br /> • Property Lines � <br /> � Cente�line of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � " <br /> PERMIT CONDITIONS O <br /> 1.All�alls for inspection sheil be made 24 hrs.in advance-phone 259-881 O. <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Desigr.and Conetructlon � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800�424-5555. <br /> �. �- ��--P��,�s �� ��3.�9 Z <br /> O <br /> F- <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> - The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everett from any and all claiins for damages, costs, <br /> — /�j expenses, or causes of action that may arise because of installation <br /> � ��1! � �- nd maintenance of the improvement ur other righPof•way use hereto � <br /> Appr f � on c ' applied lor and further agrees to remove same upon notice from the <br /> ate City and to replace lic pro erty damaged thereby. <br /> � < < <br /> AL INSPECTIO Date 9— 2'G— <br /> Approved as Constructed Signat plics t � � <br /> Date <br /> everett F'UBLIC WORKS DEPARTMENT WCRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK OU ThIIS <br /> PRUJECT OVER 90 DAYS DURATION. <br />