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� <br /> - LJHtQ� YaoliC Wods Permlt y �� � I <br /> ll i/. <br /> App�tcatlon Fcr P�Ep.Depl.• �ty e� <br /> PUBLIC WORKS PERMIT P°°��°W°�ksF°a — <br /> I TotelFee $ a0. Ol7 � <br /> . �esa ApO�fue Peltl S <br /> Print or Type Only Belan,e Due s a-d•o o _ <br /> � I.�7-Z <br /> _(��c�,ac�� ����zT�� /�3o��-,uw y 9y s�,� �� �yN,�wo� ��.�-� <br /> Owner Maliing Address —� City Zip Phone Z <br /> 7�/�s=.�oa � <br /> .. <br /> � <br /> Applicant Mailing Address City 2ip Phone �.�. <br /> Describe Proposetl Work�--I H�-�'N��� •�►'�[� V'�Wi�-•+i/1 K� •• •, <br /> --I �'I <br /> .. -� <br /> N 2 <br /> 0 <br /> m <br /> c v <br /> � m o <br /> �7// ����-r� CL,�r-�-•µ� � � <br /> Pro�ect Adtlress(if knuwn) � <br /> z -Zi <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as app�icable: � ��,.., <br /> • Property Lines • Centerline of street � � Z <br /> • Outline and diinensions of all existing and • Indicate North � s <br /> proposed atructures on the lot • Show any proposetl gradin�chenges � � <br /> • Existtng and proposed utilities • Show measurements � K y <br /> o �DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O m .. <br /> t. All calls for inspection shnll be made 24 hrs in advance•phone 259-881 5. �^ <br /> 2. All work shell be peNormed in accordance with this permit and current City of Everett Design and Construction � o r <br /> Stendards and Specfications <br /> 3. Cell Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424•5555. � m �^ <br /> 7. A4ot" '�rw�r�t c.+�t � �L � i� '.�•���✓�e'J" � hP[�.�rTT �. �J . � A <br /> �UC..'MJ! � 1 I (� <br /> 4, p � <br /> ea.st �:�e o� lr..a.....�...er -\,.rca �\' �.,� • a <br /> CKr7 �\.�� � � 2 <br /> �-i <br /> � N <br /> O Z <br /> O <br /> � <br /> r-. <br /> a � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner,'applicant hereby agrees to hold and save henn• <br /> -���� less the City ol Everett Irom any and all claims for damages, costs, _ <br /> expenses, or causes of action that may arise because of iiislnllatlo.� <br /> 1,���5/ and maintenance of the improvement or other right•of•wey use hareto <br /> � Approved for ConSiruction Date applied lor nnd lurther agrees lo remove same upon notice irom the <br /> Cit and to:epi�ce publi properry damaged thereby. <br /> � ��ar .�y �1��� 1�2o✓�cT)� <br /> FINICL INSPECTtON �ate ���V�y� ��^-^-7 2/'���� <br /> Approved as Constructed Signaturo of Applicant ' at� <br /> everett PUBLIC WURKS DEPARTMENT WONl: AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,\YA 98201 BE DILIGENTLY PURSUED TO COMPLETICIN. THtS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS ' <br /> PROJECT OVER 90 DAYS DURATION. <br /> L -� <br />