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Date�—� ���K Wo.��Par 1• ��/ <br /> Application For �'�0�°ipt�� <br /> PUBLIC WORKS PERMIT P°°��W°�,FN <br /> To�.�F„ s <br /> Leb Aool Fee PaC S <br /> Bab�ce Uua s 20�— <br /> Print or Type Only <br /> '� Ciarr� —sfsk.- f{rn«k � I°►.p.,-�.�,I�. <br /> � 3��. s� S+ ►�� w ����" q8�3 as8-��yti <br /> ':f <br /> Ow�er MaiHng Address City Zip Phone <br /> SQ�iWtQ.+ <br /> �� Applicant Meiling Address City Zip Phone <br /> :; /� <br /> ' Describe Proposed Work �� ps ��' �-�'� '^� �� 1 ��'� ���"9"^ �UQ <br /> <, �� �•— <br /> J <br /> C�ZJ.z'`-� r S�"' <br /> o � <br /> Prolect Address(if known) � u�'0 � <br /> Attach lour(4) copies of p�ans lor proposed work• Drew to scale and note the lollowing as applicable: � <br /> �� • Property Lines • Centerline ol streel � <br /> • Ouiline and dimensions of alt existing and � Intlicale North � <br /> `; proposed structures on the lot � Show any proposed grading changes <br /> � • Existing and proposed utilities • Show measurements � <br /> a <br /> � DO NOT WRITE BELOW THIS LINE <br /> �' PERMITCONDITIONS � <br /> 1.All calls tor inspection shall be mr�1e 2a hrs.in advance-phone 259•8810. ! <br /> � 2.All work shall be peAormed in a �rdance with this permit and current City of Everet�Design and Construction � <br /> � Standards and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.befare you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � 5� ��1� �n /� p� �r'.� Q.,,/„<<�f� � <br /> „?y �t+u.w»1.evr.� �f' C�YCv� �B �� �z,�C.i.�y"�C'rU�cal�ie(l� <br /> � i � <br /> (f /� � �,✓ � <br /> ! S e1eG�c.�P/� [ ��n,j,C.�02/ ,Co .��o /s-�Gf��L/ �2P— �O�-�c�G"Yv' �s <br /> :! �12E�Ctny Lc/'L�it/_ZL.�'�c.f'i Cc107/',�L Lr,.,�.�.�`'OZ �e���-LG � <br /> -lilZO-�G�iirr� J�G�Cu .SC.Cci�f/I-a. . I%--.�. � � <br /> J <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm� <br /> 3 less the City of Everelt Irom any and all claims tor damages, coats. <br /> � � expenses, or causes ol ac:nn that may arise because of instellation <br /> ' ,'/ �/!� D and mainlenance of the improvement or other right-of•way use hereto <br /> v applied lor and further agrees lo r ove sa e upon notice from the <br /> 3 ' �d roved br Cons ruction Date City and to replac public property map ereb . . <br /> i � �- FINAL INSPECTICN Date <br /> Approved as Constructed �gnature ol Applicant Dale <br /> everrtt PUBLIC�•!ORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT UST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TC <br /> � 3200CedarStreet BE DILIGENTIY PURSUED �O COMPLETION.THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:25&88t0 PROJECT OVER 90 DAYS DURATION. <br />