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��_ . _; � <br /> ,"_'°; - ,� , <br />, _ <br /> _- <br /> > �� �l ,)T"V 1 1 Pubht Works Permi• `-'� _`�Sy <br /> Date� <br /> Application For . ' a�aq.ooa�..���O�L�_ <br />� PUBLIC WORKS PERMIT P°°.o;a°Fao`°a S <br /> II� , 1c55 AOOL Fee PaiO 5 =O <br /> i� 20 <br /> 8����«o�� s <br />' Print or�yp= Only <br /> I�I <br /> ' �' �,u.� �'�aga as�-i�d� <br /> � „o.�—„�� � /ya� �n�b��� ia�, <br /> Owner Madmg Address Ciry 2ip Phone <br /> �,���� �rc�5�/� 7-r��-._�¢�.����_9�'aP2�s��� <br /> qpplicant Mailwg Ad�ss City Zip Phone <br /> Describe Proposed Work <br /> z'�R - � `� - <br /> - W <br /> Prolect Address lif known) ��-�� — `-r�`yyl.dOO.C� /�//� � <br /> AUech four(41 copies of plans for pruposed work- Draw to scale and oote the lollowi.ig as applicable: � <br /> • Froperty Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Sh�w any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall �e made 24 hrs. in adrance- phone 259•S81 5. � <br /> 2. All work shall be performed in accordance wi�h this permit and current City ol Everett Design and Construction <br /> � Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEP 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �Q� ACKNOWLEDGEMENT OF CONDITIONS <br /> �v <br /> The undersigned owner/applic�nt hereby agrees fo hold and save harm- <br /> less the Ciry ol Everetl irom any and all claims lor damages, wsts. <br /> expenses, or causes ol action that may arise because of installation <br /> � J ✓ o and mamtenance of the improvement or other righbol-wav ase hereto <br /> �-�� ���� - ! �E applied for and lurther agrees to remove same upon nnLce trom the. <br /> Approved lor Construction / �a�e City and t eplace public prop damaged thereby. <br /> �,�,/ Gf-�� F-� /� � � <br /> �INAI.M E 710N Date <br /> : Approved as Constructed S� natu e ol App Icant Date <br /> everett PUBLIC WORKS DEPARTMENT W RK UTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> 18 DA S OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 320G Cedar Street EE D ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98207 CF.NCELLED BYTHE CITY UPON ANY STOPPAGE OF WOFiK ON THIS <br /> Phone: 259•8815 pqOJECT OVER 90 DAYS DURATION. <br />