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t <br /> Il � <br /> Date 9/3,��5 " <br /> Pubhc Wo.•:a Permit• a5--3/9 <br /> Applicallon For Bltlg.DeoL+ <br /> PUBLIC WORKS PERMIT '°'To,aFaeFeO : <br /> lassAppl Fe�r PaIU $ <br /> Print or Type Only Balance D�o s ��' <br /> ����� <br /> �'Lo��'nJ JNn�k�n1s /�� I �u 1�or✓ .fi�F�PE7� %�ao/ �.s�� /�/l0 7�i/ <br /> Owner Mailing Address City Zip Phone <br /> z <br /> 0 <br /> -� <br /> Applicant Mailing Address City Zip Phone c <br /> m <br /> Describe Proposed Work C �YY�C It�� lJ� I l�C CC)A�(� M M <br /> � � <br /> �. —i <br /> Vf x <br /> 0 <br /> m <br /> W = � <br /> m� <br /> Project Address(it known) � 2/— L�"O� � 0 3 <br /> Attach four(4)copies ot plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � _ '"'� <br /> m <br /> • Property Lines • Centerline of sireet ""' <br /> • Oul�ine and dimensions of all existing and • Indicate North � c Z <br /> proposed structures on ihe lot • Show an D "'� <br /> y proposed grading changes r x <br /> � Existing and proposed utilities • Show measuremer,ts � � y <br /> < <br /> DO NOT WRITE BELOW THIS LiNE p z <br /> � 3 <br /> PERMITCONDITIONS ,� m <br /> x <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � m.-� <br /> 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction N <br /> Standards and Specifications. o r <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � c vmi <br /> 3 tn <br /> m <br /> � � �m <br /> , A <br /> U•C'/UEWd� T'p ,/��'" L'O.tJST/'GC'TEl� AS G'G o5 E� TE' � <br /> � <br /> C„—y �;o.�a�,°U �07- AS� •`�s5;.c-t�E ., ' <br /> z <br /> � � <br /> x <br /> ... <br /> O N <br /> z <br /> 0 <br /> a � <br /> � � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Citv of Everetl Irom any and all claims tor damac�es, costs, <br /> J expenses, or causes ot action that may nrise because ol installation <br /> ������� /1L �n/�/qs- and mainlenance ot the improvement or other righFobway use herelo <br /> � ,�� applied for and lurther agrees to remove same upon notice Irom the <br /> Approved for Consl�uction ���e C.ty and lo�replace public property damaged thereby. <br /> �������3 -�C r� <br /> F1�NS�ECTION Date � ��'3 '�5J <br /> �pproved as Constructed Sig re ol Applicant Date <br /> W K AUTHORI=ED THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT ig0 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett, WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />