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. � <br /> ., , ^ <br /> . • <br /> �B�B� ,3 PypliG Works Permit• �� � � <br /> Applicatlon For eiay.oeo�•� �-���� <br /> Pll�LIC WORKS PERMIT PuDTotNFeeFee s �, o � — � <br /> I lesa AD��Fee PeiE s <br /> Bslence Due S �' �� <br /> Print or Type Only <br /> �9Y9� <br /> �,� ���efic� P� ��?� SG EJPk'�?` YYL4LI LIJ., nl a 3�5-5'�/? <br /> wner Meilinp Address City Zip Phone <br /> z <br /> _ ��m � � <br /> ., <br /> Applicact Alailing Address Clry 2ip phone m <br /> ( .. <br /> Describe Proposed Wcrk �/ �„� � <br /> --1 �l <br /> � -� <br /> V1 S <br /> 0 <br /> m <br /> O /` W = � <br /> m o <br /> Pro�ect Address(if known) s / � � l� P✓� CN�O `�', � o � <br /> -i z <br /> Attech four(4) copies ot p�ens lor proposed work• Draw to scale and note ihe following as applicable: � _� <br /> m <br /> • Property Lines • �enterline of street "" <br /> • Outline end dimensions of all existing and • Indicate North � c = <br /> proposed structures on the lot • Show any proposed grading changes ra- _ <br /> � Existing end proposed utllities • Show measurements � N <br /> DO NOT WRITE BELOW THIS LINE � O A <br /> T <br /> PERMIT CONDITIONS -r� <br /> 1. All calls for inspectlon sha�l be mede 24 hrs in advance• phone 259•887 5. � m N <br /> 2. All work shell ba pertormed in accordance with this permit and current City af Everett Design and Construction p <br /> Standards and Specilicatlons <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � � N <br /> 3 N <br /> z c'+ <br /> O :�m <br /> A <br /> � <br /> � <br /> a <br /> z <br /> � � <br /> x <br /> ... <br /> O N <br /> z <br /> 0 <br /> -i <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersig�ed owner/applicant hereby agrees to hold and seve harm• <br /> loss the City of Everetl from any and all claims for daraages, costs, <br /> �—� � expenses, or ca��es of action thet may arise becauso ot i�stallation <br /> C��`_ �/�_� and maintenance of the improvement or other right•of•way use hereto <br /> -� Approved lor Construction Date applied for and further agrees to remove same upon notice from the ` <br /> City and to replace public property damaged thereby. <br /> AL I�� C �91�!/ J-�r-�Y y,,, �� ,�,� / <br /> N Date i�/1-fa.�-lL,d�2.i� 7�C4'iO�C, .5-.21-.�4- <br /> Approved as Constructed Signature of Applicant Dato <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 25�J•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS ,; <br /> PROJECT OVER 90 DAYS DURATION. <br /> L � <br />