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Lr- <br /> v 3�-�9_� <br /> oace�a �s�8s 8S—.= s��— <br /> PUELc Worke Permq• <br /> Application For eieo.oeo�.• ___._ <br /> PUBLIC WORKS PE�iMIT PueTo�Fe6F�� : <br /> Les..Appl Fee Paid S <br /> Belan�e0ue $ �C�pp <br /> Print �r Type Only - <br /> 770 3 z <br /> J�E.�'omE iUi�cs�.d 36i7- �a.�i�T�'o��Ol. Ev�'.e�c>l 9820� .���sy.�� <br /> Owner Mailing Address City Zip Phone <br /> S GmE <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work . C��S7.e(JGT .$,F�� <br /> — r,-- <br /> ��o� — --- W <br /> �•o�ect Address(if known) . � —" G��'�CVOOp /�E.� � <br /> tach four(4)copies of plan;lor proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Gr.nterline of street � <br /> • Out�ine and dimensions of all existing ond • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing end proposed utilities • Show measurements � <br /> DO NOT WqITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for insper.tion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All wor4 shall bo performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards antl Specificalions. <br /> 3. Cnll Location Underground Service 48 hrs. before you dig.TOLL FHEE NUMBER 1•800•424•5555. � <br /> Y. �O�/ST,eClGT SGE C��t6G.� �GpiC>� S,�'O.eT�GdT <br /> ST.e�'ET fo.vT'v� l�F� S/'a�r Pia r Co�DiTicwS . O <br /> �Oi'c'icil.vT �a.s P.2cfvi.oEd f�;,Pmv.dc� Gda.caM� � <br /> F�e s.��va�,c� <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol C-verett trom any and all claims tor darnages, costs, <br /> ,�/j/l ' iy, expenses. or causes ol action that m3y arise because of installation <br /> �y��� '- `��0�'� -/—✓ � an� inainlenance of tne improvement or other right-of-waY use hereto <br /> l�fL/ �� applied for nnd lurther agrees to remove same upon notice Irom the <br /> Approved for Co truction Date Cit and to replace public property damaged thereby. <br /> � �w'iG/ S—/G �i ///� / �] p� <br /> NALINSPECTION Date ' �/i,E!�6� D��C7S�W <br /> Approved as Constructed ignature ApplicanC � Date <br /> everett PUBLIC WORKS UEPARTMEMT WORK�NUTHORIZED B� TH�S PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUFD ANO THEREAFTER IS 70 <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY TI1E CITY UPON ANY STOPPAGE OF VJORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />