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,. � <br /> J'—J <br /> �at@ / 3/�� �`, . • �. � PuE6c Worka Permll• '� �/ <br /> Bldp.DeO�• <br /> Applicatlon For „�. <br /> PUBLIC 11NORKS PERMIT F�p1;+biFneF�' s <br /> . Len ApD' Fee P�IE S— <br /> Bal�nce Duc S `�'n� <br /> PrintorTypeOnly i��?_3�_�_�in-DG'O//-<�=j <br /> 2`a-:�- 7551 <br /> .�i ^.��,rir �7 �/ `Jd,� ii� i v��G'�"=, ,�,�-�� �7' ��7✓J3 ."'r�3-/�7 `.�' <br /> Owner MaflfngAddress City Zip Phone <br /> �'��� E Phone I <br /> Applicant Mailing Address ���Y Z�p I <br /> DeacribeProposedWork �..BE!�."'r�`'..-_,.r .'�����i��-Y/i' E;� �� <br /> Go % � [, '�'�7��� �����e� �� �— <br /> _. W � <br /> Pro�ect Address(if known) ���/� "- =���'��`=/� Q��E � <br /> Attach(our(4)copies ot ptans for proCP�• Draw to scale and note the following as aPPiicable. � <br /> �• Pro(.+er'y Lines � Centarline of street ' <br /> � Oulline �nd dimensions of a exjsting end • Indicate North <br /> pruposed structures on the�yt'-�•� • Show any praposed grading changes <br /> , • Ezisting and D�oposed utilitfes • Show measurements M <br /> W <br /> DO NOT WRITE BELOVJ THIS LINE � <br /> PERMIT CONDITIONS � � <br /> �. All calls for inspecllon shell be made 24 hr& in advance• phnne 259•881 5. � <br /> 2. All work shall be pertormed in accordance WitKih(s permit and current City of Everett Design and Construction <br /> Standards end Speciticetions. � �' <br /> 3. Calt Location Underground Service 48 hra before yau dig.TOLL FPEE NUMBER 1-SOO•424•5555. � <br /> f� �O./F i4.✓D S/TE SU•E'FdC_.f: �•;��7-c.i: ?�� [�.�.'Gin/ � �v. <br /> -:�; ���s���y aE-�i.,io srou_5;�.. <br /> / �� <br /> ;-V�LG BE .PE°��C�.I<-'C.i TG COhI.�'CrTEL� <br /> .>, �:!'i.=.F i.-41iLi,Y <br /> �E�;oa�- Cuz�3f Gu>T�%> d- O.eiv���«,AY � EirNEx' f,'f/ � <br /> �!i</ C t�.'Ti.</G- O�C .CE/r�n ve [. J;:� /�/•`"��=�sT E.Yi�a Ni<.ir�J Q <br /> =T;in�T. .�lvoC.�i JG i'L� T,E :•or' ;�= Cu.eB Tv Ci'�a?r /� <br /> i.r / .r�!7.t.�i,ic ��!n.:�% /!/G7 =iLl�'!✓=li, f� <br /> ��.i./i � :� <1� �:� <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> � � Tha undersigned owner/applicant hereby agrees to hold and save harm• <br /> �� '� less ihe City ol Everett Irom any and all claims for damages, cosls, <br /> exp�nses. or causes of action Ihat may arise because of Instailation <br /> �,// � .� �no mainteiiance of the improvement or other right•of•way use heielo <br /> `71(�f-�fi ��Y�r�� —� Z�`'�-` applied lor and further agrees to remove same upon nolice Irom the <br /> Approved for Construction ��e City and to replace public proPerty damage� thereby. <br /> i <br /> ��� � ��� -.'<i -G� <br /> Date - in• rt� � ��� � -�'�+'� ' <br /> ; FIMAL INSPECTION Signature cl Applicant' ^ Oate <br /> i Approved as Consiructed <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED N'I7HIP1 <br /> evere[t PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200 Cedar Streot pF DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 tAal' BF <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK UN'HIL <br /> Phone: 259�8815 PF�OJECT OVER 90 DAYS DURATION. <br />