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..rxt,.�t � -. . 7-> ._ � ' „ �,'��7 ..,;,,,.f�i'�i,�.�t�t�'„���'�,wyK�„ <br /> . � .. , d^<S�i,w _,��qsY^i:'i•�i�t..r1�t.. �, t�r�p�NT;},,ti" ��� 'µ:. <br /> Date9" 5_5I PubhcWorMsPermq• / /��1� <br /> Biag Oept• <br /> Application For <br /> PUBLIC WORKS PERMIT PueecWorksFee <br /> Total Fee `S <br /> Less ApO��Fee Faid S <br /> 9alance0ue S �n-�� <br /> Print or Type Only <br /> - � .:� . <br /> �, ,n ���c rv.,rri I�O3� Yc I�-, /�✓v ,�vC.rE � /�8,2c�1 �?59- Yl7 D � <br /> Owner Mailing Address C�ty Zip Phone . <br /> � a m ._e.� <br /> �I Applicant Mailing Address Ciry Zip Phone <br /> IDescribe Proposed Work I w� � ��' y �a.rc�C �✓� S 6�E ����� ��� <br /> W <br /> Project Address(il known) � <br /> Attach four(4)copies ol plans lor proposed work- DraH�to scale and nole the following as applicable: � <br /> • Property Lines • CeNerline o(streel � � <br /> • Outline and dimensions ol all existlng and • Indicate North <br /> proposed structures on 7he lot • Show any proposed grading changes <br /> • Eristing and proposed ulilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDiTIONS <br /> 1.All calls for inspection shall 6e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be perlormed in accordance wilh this permit and current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Under9round Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> `� /�o�,E-o�'F ��'•�.� y�.6 �Qw �c� or� �..,�.,J O 1 <br /> �� :�t.�l`� .c�.e.� n�,�o-,� 2..�0 ,ac�u�� <br /> � <br /> �.�c�'o,,,�i�, ''� _.S'-r'n->,����'�_308 �����r!�-,�,sr_�� � . <br /> � <br /> O <br /> ; a <br /> 1J'c,I�EW�y �P,�,a� i�i <br /> hu1 6��,� f�S�4�ced . � 1 <br /> ^ /� / , 7 - . ACKNOWLEDGEMENT OF CONDITIONS <br /> ���r q'Z¢'�3 �/E'CQ �✓/QL✓, 7 The undersignetl owner/applicant hereby ac rees to hold and save harm� <br /> — ? Iess the Clry of Everett irom any and all claims lor damages, costs. <br /> ; f ezpenses, or causes of action that may arise because of installation <br /> . �//J� q�b�� and maintenance of the improvement or other nght-oFway use hereto <br /> f''� ��'� / � applied for and luriher agrees to remove same upon notice irom the <br /> Approved lor Cons�ruclion . p t, �a1e City and to replace public properry damaged thereby. <br /> � � n / <br /> FINAL INSPECTION � Date y� .o. ��q � �.e 7-I U "�/ <br /> Approved as Construcled Si9nature of Applicanl Date <br /> - / PUBLIC WORKSDEPARTMENT �RI� AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 780 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreet - BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />