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r Date'�T �i^��� <br />Applicatlon For <br />� PUBLI WORKS <br />- Print or Type Only <br />i�c�ti�� C �vdznso�v �l ( 3 <br />� Owner Mailir <br />AppliCant <br />Describe Proposr.d Work <br />Pu�hc Worh¢ Perm�t M __,J� <br />BIO9. DePt ♦ _ _ <br />P E R M 1 T Pu01ic Works Foo �IJ <br />TatalFee S �� <br />� Lo]] ApOI FeB PBiC S <br />Beiance �ue S '� � <br />Mailing Address <br />r�rv <br />Zip <br />Zip <br />. % Z SFy.3 <br />% 3� 0�� <br />Phone <br />�--- <br />Phone <br />Sd� �iou.�/ <br />l'-!7 �K � f� G. /'�h.i�r � l��/ _ r <br />�..�T <br />PioleclAddress�ifknow � 7y� %^�� i'�ptv �-Ci hov f'lf.P� <br />Attach (our (4) copies ol plans or proposetl work • Oraw to scale antl note the following as applicable: <br />• Properry Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structure5 nn the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />�r�r <br />PERMIT COND�TIONS <br />7. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City ol Everett Demgn and Consiruction <br />Stantlards and Specifications. <br />3. Call Location Underyround Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�! c�jQ/nlf�, G'E a>/G C c�c Co nf/�oLLc�/J /,�S �J/�'cc'T�+�� <br /><+�� //l�' C� C /�,e . ,.�'�L �O.P/�//�?l�c � <br />�i�v�c� � crJi'GG c3�c= �'cm�% i?/��� o71J <br />ion <br />�O <br />FINAL INSPECTIOM �� � \ <br />Approved as Constr��c d <br />evrmtt PUBLIC R S DEPARTM <br />3200 Cr.dar Street <br />Everelt, VJA 98207 <br />Phone:259�8815 <br />1 . <br />L <br />f�i�/6J�T�� <br />Sii= <br />� <br />� <br />ACKNOWLEDGEh1ENT OF CONDITIONS <br />The undersigned owner/applicant hereby agiees to hold and save harm� <br />less Ihr. Cily of Everett ffom any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and mamtenance ot the improvement or other righFohway use he�eto <br />ap �- r and lurther agrees to remove same on notice Irom Ihe <br />Ity and to\rep�ace public propQrry d2 er�by. <br />RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY3 OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COP�IPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON iHIS <br />PROJECT OVER 90 DAYS DURATION. <br />_ . J <br />� <br />4. <br />