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Dat�;_�/ � 7=,�J� <br /> Cutl'C Waks Parmit� �^�'� <br /> Application For � d�oc�ran!.+ ` �� � /, �_ <br /> PUB�IC UJ4RKS PERMIT PuOiir,W�rksFee <br /> To�z�fuo s_ <br /> Loss Appl Fae oaitl S __ <br /> U <br /> Pri�� or Type Or.ly ea�e��ao�o 5 ZQ '�— <br /> i��i�:—,�l�ieh ���� � � �5�n�� �1r���'%� ��-�I��g <br /> wner MaiGng Address City Zin �hone <br /> ��[dL.(.( � .. <br /> Applicant Mailing Address City Zip Phona <br /> DescribP Proposed Work I fN�a 7 �\(��_ <br /> Prolect Address(if known) 7p33 - � �yLE,� l�,E' � � <br /> Aflach tour(41 copies of plans for proposed work• Draw to scale and note the(ollo�ving as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Oulline and dimensions of all exislin9 and • Indicate North <br /> proposed structures on the lot • Show any proposed�radinc�changes <br /> • Existinp and proposed utilities • Sliow measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIO�� <br /> 1. All calls lor inspection shall be r,�ade 24 hra in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in eccordance with this permit and current City of Everelt Desic�n and Construction <br /> Standards and Specilications. <br /> 3. Cell Location Underpround Service 48 hrs. be(ore you dig.TOLL FREE tJUMBER 1•800•424-5555. � <br /> 7; �'C-sU.C/SL'Tic2fl 70 .S�OC'i�7 G).f'T%f/!�� Sf;S�c`%,? iT�c!ST i,%t' O <br /> _.'.��5/�E CTEv .L�.�-fl�c'E `�vEi'iNG � c."/�C G F.'ii� .Z�t/J:�'c C%�o.l� <br /> ��,v.E d�y ,� .�'.oG�i✓cc �. <br /> �. Gcu.ul�CTio�r/ /�� �f'OGy�'YoP .�ci�c%uf"�=o�'�S' �o C�T}/' �qrC�+ � <br /> /��/� /�'JU.IT .c4�' Driit/E .Po C./i7i�% .�f' ���%.(/. / �, r � <br /> „ �,��. f,f�._ o <br /> O�' Y �v.C. �c/iTi;/ ��r C�A.J7 2] cS'.�c.�-E ��,vO <br /> N19�n1T9i.t/ A .3' Co�:F.e iF a�.n��E .. A <br /> ii <br /> G'. �XiSii.r/!r C.d �'.�in� 9.Ul.J G�9�Es' .9.��� �v_,=.� ;�/�G�9n'9l^�L�� <br /> A�c/f/ t�9M9G�D A�ia�NG TN/S COnJs,�'�<T,�..✓ �,Jo:.rT ,�c <br /> .'['�/�LfJCFO G3(/ 9Pi�iCh'�✓%„ ACKNOWLEDGEMENTOFCONDITIONS <br /> � The undersigneA owner/applicant hereby ac�rees to hold and savo h;�m- <br /> less the City of Everelt from any and all claims for damages costs, <br /> expenses, or causes of action that may arise because ol installation <br /> h/ ° antl maintenance of the improvement or other ric�hl•ol•way use nerelo <br /> �"' ���Z'�y�-� applied (or and furiher agrees fo remove same upon notice irom the <br /> ApprovedforConsV ti Dale <br /> City and to replace public prope�ty damaged thoreby. <br /> � � /, <br /> FINALI� 10 Oate �F�7.� /' //,- �� l� �/-�C' ���� <br /> Approied ss Construcled Signatur�of Applicant Da�e <br /> evereu PUBLIC WOR S DEPARTMENT v✓ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedai Street 180 DAYS OF DATE PC-RA11T IS ISSUED AND THEREAFTER I� 70 <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TH!S PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />