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D2te `� d 1/`�'i �: -.._ <br /> �` 9 / / <br /> P�EIi�Works Permn a <br /> Application For � eioo.oeai.. <br /> PUBLIC WORKS �ERMlT PuOToialFeeFea S � <br /> R <br /> � <br /> � Less Appt Fee Paitl S�,��_ <br /> Print or Type Only � oo nb BalanceDue S zOe— <br /> �; � o oaz-3zzyri�s�/ woer,. ����- 35a�� <br /> � ~ NUME 3S'i-a,9�U <br /> SD1aN S_ LEVAI�IDUW$Y�.i, %6�1 W GLeN 1�� EUFRCTT 9e�.U3 <br /> Owner Mailing Atldr�y�o N � P <br /> ���Y Z� Phone <br /> �AME A�' R�UVN. � � o � <br /> Applicant Mailing Address �i�Y Zi <br /> P Phone <br /> DescribeProposedWork RCMUVF '��� ��,�SH�T$ Q 2[/lULn �L�ZMSTSSUIJ TU FL�NC� SN <br /> wn�. RI.f�W�A9iE ZE;A1Pa�2ARw FL•`NCSNG nPPZUX 3U�X_ 4,S � ;�;CZSUN UF <br /> Mk,R�D7'AN RD �ASEMCNT FU2 l'ERSUNN/�l. �,►�ZUYMI�NT A.Np ViPK4'rep, <br /> TE1�T Cii�( 3 �AR6F Rl\lrR Z\2Y!*S pN M�.i��GTAN ' � NUT l'��' Rl�MCVL'D Wi" W <br /> ProlectAddress(ifknown) M�T.�tZOS N LAS6ML% N� OSIZ�IAY WeSZ UF lo�,yw ���u �R � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the lollowing as applicable: <br /> • Property Lines • Centerline of street — <br /> • Outline and dimensions of all existing antl • Intlicate North � <br /> proposetl structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•881 O. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Call Locatton Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800�424•5555. <br /> 7 /`lis�ivn�� /s �� use o{f/e �u6Cic l�i�o��,�c� � <br /> ,�y�f -of ��Qy d,��y 4.�� .s .�of �•� �„�y � <br /> 9r2d � orFy�n��y or f:ll.n9 or �r an� �oi-cvio�s' � <br /> in �r i � <br /> .S S/io��c� �5e �'e�i s�e� 7`0 �.se �..s .Py�f-or�=tc/ay O <br /> f� 7'�'Un/�or�zr� 7-�nGf J'�+.lC 6e /�h�vvee� 6y f�iC <br /> Q��Gca nf a <br /> , <br /> �o. �e;�cc s/a lL 6c 2 max,.•-�v..-�. a� lv ��ll p�=^ �e <br /> f.' <br /> C��y z�or,.:,J Cooe - t✓iLl �e[f -�'!ie S�rrou.,d�y o�rant, c <br /> 7 /V� , !a/or.f' iJ f0 Ge c�ond '��'� ACKNOVJLEDGEMENT OF CONDITIONS <br /> - I-o '�'�/ps The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Cily of Everell Irom any and all claims for damages, costs, <br /> y7�L//�/� / �-/s�� expenses. or causes of action that may arise b9cause of installation <br /> j�(J/ O�r�--� and maintenance of the improvement or other ri hbof-way use hereto <br /> Approved lor Construction '—� Dale applied for and further agrees to remove same upon notice Irom ihe <br /> �� Cily and to replace puGlic property amaged thereby. <br /> �� t.-.-�� -- <br /> FINAL INSPCCTION Date - c � � ` 9y <br /> Approved as ConsVucted Sig ature I Ap{y cant <br /> Date <br /> ��r� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TliIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> t� i <br />