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y <br /> / <br /> • yp =:4 90- 3s� <br /> �,dt � Pu�Lc Worb Pe�mll n <br /> p^� 4pplication For 81tl9 Oept� <br /> c.l <br /> PU�LIC WORKS PERMIT '°°'�°W°�k°`Ce <br /> .o�r�F�� s <br /> 0 <br /> 0 �ess aooi.Fee aa�e $ <br /> a 0o Balanceoue $ ��Oa <br /> Print or Type Only-��- � " <br /> o � ���, OOZ-32Z yo_ OOG-/7-�?/ <br /> � � <br /> CRn` .I�•v� � ��s�I FRt�N ���• �Vr�TT �'sZo4 ���.79`�"3 <br /> Owner � e�c�i � Mailing Address Cily 2ip Phone <br /> i arw <br /> /� . C2iT ' ���t � � 3g�t F,���Y �� �v�.C�rT' �`1 25�-'7283 <br /> App��cant Mailing Address City Zip Phone <br /> Describe Proposed Work '1 !' CNA�f'U �-INK FF��(�� �2UUN� � ,57F��T•slv�5 C�F <br /> Pp.(�x/L�Y A�n Ab��Ni�il� �`��srrNG- Fr�.ccw5 �N ��-ruet2 � S�O�s aF feK�f�e La7. <br /> W <br /> Prolect Address(if known) '�'�'�'�� �S ��V� � <br /> Attach four(4�copies ot plans lor proposed work� Dr.�w to scale and note the lollowing as applicable: � <br /> � Property Lines • Cenlerline ol sireet � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> propo�ed structures on tiie lot • Show any proposed gradmg changes <br /> � Existing and proposed utili�ies • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shnll be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be peAormed in accordance with this permit and currenl City of Everett Design and Conslruction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.hefore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> ✓�i, �GoLcc� �7t��G�+C /Le��ov�ea/��ar� �c� 'C'cL�z/ �'��� - O <br /> c� .,e �� 1 // <br /> _� (,�f�uj .(iiL �/�c/ �'LY/��/ �G/12 ��� �L'LL� '�"tCCCL:Y <br /> � �c O�L� lt/� �h. ,�La Q/Le2�� .�'�.��uG --�'%�la.�l' � <br /> � ��� _ !� _� nn�!!/ �1�T2ctGY 2f ��/"'YtC21l �1l�OC�ai.C.C•e N <br /> O U`c" c�/��� � <br /> — a <br /> ACKtJCWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to ho�d and save harm� <br /> O� P�.•�, D�y��s. G�6�En,y ' less the City ol Everelt Irom any and all claims for damages, cosis. <br /> ezpenses, or causes ol action thal may arise hecause ol installation <br /> ` � / �� .� and maintenance of Ihe improvemenl or other righbof�way use hereto <br /> ,��1 0 _ applied for and further agrees to remove same upon notice lrom the <br /> Approved for Constr GUon Date City and to replace public property damaged thereUy. i <br /> y� / <br /> —(',�� '�%/" �r— �� %�' ��<<� ,,u�- 07 ,2S l� <br /> FINAL INSP CTION Date � <br /> Approved as Constructed Si�nalure�ol Appl ca t Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrett PU6JC WORKS DEPARTMENT 180 DAYS OF DFlTE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOnK ON i HIS <br /> Phone:259�0810 PROJECT OVER 90 DAYS DURATION. <br />