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I Pu�lic Wa�ks�'ermn• �" �`�J3 <br /> Date�� , e�aa.o�u�.. ����19� <br /> Application For <br /> PUSLIC WORKS PERMIT �ubToluFcoFce g <br /> Less AppL Fee Pa�d � O <br /> Balanca Due $ �Q Q� <br /> Pric'. or Type Only <br /> l , g' <br /> wner� Mailing Address � , City Zip hone <br /> �-�Y1-«lL <br /> Applicant Mailing Address CitY ZiP Phone <br /> Describe Proposed Work _.1�.L•L1-1�� <br /> W <br /> Project Address(i1 known) 3 — E 7G E L7.<' � <br /> Attach tour(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines . • Centerline of streel � <br /> • Outline and dimensions of all existinp and • Indicate Norih <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> ' DO NOT WRITE BELOW THIS LINE O <br /> I PERMITCONDITIONS <br /> � 1. Atl calls for inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be perbrmed in accordance with this permit and current City of Ew�retr Desic�n and Constructioo <br /> � Standards and Specilicatio�s. <br /> 3. Call Location Underground Service 4B hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> I O� �j,� C'cw.u,�'c;.av �'o sracin v.�9-•r���- sys,-E� .1->ds r 9� <br /> i 1.�I�c�CTE�J ,�,F/�c'E �I'IVE.e/NG — CfJCC FK �NJ'.�gCi�n.�l <br /> G'N.E IJ9y ,�/ .S.OG/'i�Cc� � <br /> I �i ,5� Gcx.w�'CT�o� �w-e �f'aG�'TnP JJac�.c�cf>�nc�is' To C/Tj� l9icir <br /> j �qJ'i.✓ /�UJi ,B�' Dcr�/E so c./i�f/ A i>r.v� Di.9. .'�i.�.�" O <br /> .� O� y'�P, v_C_ Gdi�// A�' C�A.r� �j �S"tov� A.vo <br /> MHi.�/i9inJ /9 3' Co�i_�.e /F �o.IDacE .. a <br /> G. E".ris.-.,dlr Cr� F,eq�� q,vt� G-29TEs f�.P�' •Vvc✓ u.rlD9��71-fl7� <br /> A�tJf/ [�qinq�.�p DUrdia>G Ti/is CoNs,-i'ricT.c.✓ ����:s' �c <br /> ���19�,�� aY yn��,�y�.,,; ACKNOWLEDGEMENT OF CONDIT�ONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ol inslallation <br /> /{�� � and maintenance ol lhe improvement or olher right•of�wey use hereto <br /> �/��.sb N9c>vP�- applied lor and further agrees to remove same upon nolice Irom the <br /> Approved for Constr tio Date City and lo replace puhlic property damaged thereby. <br /> � � ^_ /�� � � /� <br /> FINAL IN 101 �a�e l^ � + / '�C �� <br /> Approved as Consiructed �Signalu of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WOR S DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTI.Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED UY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phcne: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> au <br />