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� <br /> � <br /> '1 <br /> Date� � � PUDIic Warka Permn r �`� y�_ <br /> Appilcatlon For eiav�o�n�. ��. g� ___ <br /> PUBLIC WORKS PERMIT PuOilcWnrkaFee - <br /> TciN Pee S �'V� <br /> Leaa AOV�Fae PaiE S � <br /> � Print or Type Only BelenceDua s aU.Op <br /> ���57� <br /> 6�/LLAc'� Pk'oP£-ae7y�� /63�3 lfiuf' 9Y s'�(/r� /-�3 �Cih^Uwoc� 9803� ��S 3/eo <br /> Owner Malling Address City Zip '�Phone <br /> z <br /> 0 <br /> APPlitant -i <br /> Mailing Address City Zip Phone n <br /> m <br /> Describe Proposed Work C�U57ACl GT/O.l� Of 3'/,(/d-Ll— ff}/y/L}' • <br /> y /'cf`�S�A�Nc �' <br /> .. ., <br /> � � <br /> .. .i <br /> N 2 <br /> m <br /> W mo <br /> Project Address(if known) �7�3 C�L�,(y�LC/C��/) f}/f� � � <br /> om <br /> Attach(aur(4)copies of piens for proposed work• Drew to scate and note the fol�owing as appiicable: �� <br /> • Praperty Lines m � <br /> • Centerline of street � � <br /> • Outline and dlmensions of all ezisting and • Indicate North C z <br /> proposed structures on the lot • Show uny proposed grading changes y,� <br /> • Existing and proposed utilities • Show measurements � r x <br /> � N <br /> DO NOT WqITE BELOW THIS LINE <br /> O O 3 <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs in edvance•phone 259•881$, '"'� m <br /> � <br /> 2. All work shall be pertormed in accordance with this permit and current CiW of Everett Design and Consiruction m `� <br /> Standerds and Specificatlons o �^ <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � n m <br /> c v+ <br /> !j r1 ` ` 1 1� .+. 3 V� <br /> �. l<<aot- c1fQ �nt ci�c �v bC '�.'h�'Inr V� �\t'MP7� ` . � � 2C7 <br /> �Ot���cl w� I f 1 �) _ 1r <br /> Ovl� LQ� i- S�Q '` U� Kqr.+...r/- kPLieY m <br /> Ih � <br /> C�nrb �\�.� . <br /> � � <br /> 2 <br /> a <br /> z <br /> � � <br /> x <br /> .. <br /> O N <br /> z <br /> 0 <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harri- <br /> Iess the City ol Everett Irom any and all claims for damages, cnsts, <br /> / expenses, or causes ol action that may arise because ot installati�n <br /> ��,�/J ���K�---- �. .!!+ �y and maintenance ol Ihe improvement or other righFof-way use hereto <br /> A¢proved lor Construction pa1e applied lor and further agrees to removo same upon notice from ihe <br /> City and to replace public property damaged theraby. <br /> �� �" , a'l�c ff�F ,��o�f,e r��s _. <br /> 1�������C� /-�r-s� ����./� Sy . <br /> FINAL-JN$PECTION Date � G��+u� •2 ' -; ` <br /> Approved as Constructed Signature ol Applicant Date <br /> ^verett PUBLIC WORKS DEPARTMENT W��h AUTHORIZED BY THIS PERMIT MUST BE S7ARTE0 WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUF.D AND THEiiEAFTER IS TO <br /> Everatt,WA 98201 BE DILIGENTIY PURSUED TO COMPI.ETION. THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BYTHE CITY UPON AN`:STOPPAGE OF WORK ON THIS <br /> � Pf70JECT OVER 90 DAYS DURATION. I <br /> L <br /> _1 <br />