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✓ <br /> Date�r' /'-j Fvei,c worha Peemn. C�l/�" ��/ <br /> :=' o��,a oeo� � -- <br /> Applicalion For <br /> PU�LIC WORKS PERMIT PUbToalFecFce 5 --- <br /> less Appl Fer�w0 $ <br /> S _/O�— <br /> Baiance Duc <br /> Print or Type Only <br /> �nivil� � r .< � h-�� .r iJ �'c i����Nc i/9.z 7- _<"�t.l sc� c G- ��t"��; j��:�,� �'�'�-�c��• <br /> Owner Mailing AAdiess C�IY ZiP Phone <br /> wpeK� 3s�z-SL�y <br /> J Applican� Mading Address City Lp Phone <br /> ,�'c,nac'� r,�'cE,s'/'o,s:Si/;�e- �l^G--,,, ��. c: s.z��r_= 7,� i <br /> Describe Proposed Work . ^ f ' <br /> Qci� //V ��I(�ll'r !.�'�l � Gf: i� <br /> S�,SA�� W <br /> ,.,�._.�� G.'�,�F.-�� ���o�; ,� �' <br /> Project AdAress(il knownl �� '� ` v <br /> Attach four(41 copies ot plans lor proposed work• Oraw to scale and note tlie tollowing as applicable: � <br /> • Property !ines • Centerline of street ♦L� <br /> • OuUine anJ dimensions ol all existing and • Indicate North V� <br /> proposed siructures on the lo� • Show any proposed grading changes <br /> • Existing anA propc�ed utilities • Show measurements � <br /> DO NOT WRITE BELOW �HIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in adva�ce-phone 259•8810. <br /> 2.All work shall be pedormed in accordance wilh this permit and currenl Ciry ot Everett Design and ConstrucUon I <br /> Slandards and Specitications. <br /> ;;.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �' �LR/ eWLeG'� .W ✓Co 2G /c'e�.Ft� 'C .CP�N+. [r-C GL�t �L�+n.G�' O <br /> 5. �l�c.��r� .�o �to` .6.e ��� �Cc,fy ��u�•� �325�(9rrau�Eo) <br /> �,� cp O/i��la C��iKtea� � T��c�ri dfw � '', <br /> lv. �'[r•� � � <br /> ��Z`/LCl C�tiL[�Gcd�r.�t� ���' 07/12/89 4��4FhS OOORN5748 <br /> r/ <br /> 7. .yizR ' � Cmtz"u��F �.�c< �Gc � ,r.�tr�Q�%�'�'';, z`/�i I <br /> ��^ , , � -� M009^z073 O ' <br /> � �.�i�/�l«r G�d�y .r,w-�7�Y .G.v�-�iueT�u� . DF.UWV ��0.00 � � <br /> ���t� , � <br /> d��f-�.:. /n CHECI; 5�0.00 <br /> t-� CLyfSJ /E�d)tC7�ZCtG. i<t^'' O'>: �J L� �Cc.�cU .�2PQ.�`!/u/ I <br /> " �l/ n�r r p� /J-c�.i'�cin� 4.�Cn�, �/��� ,d�iccf � <br /> ..CIL:l�C2(�(4,C`G'r,1�I O i <br /> /<�,y�3..:J 2/ ��Gv �h'w-1-� —�x�`��' ACI:NOWLEDGEMENTOFCONDITIONS � <br /> ll The untlersigned owner/applicant hereby agrees to hold and save harm- <br /> —� less the Cily of Everett Irom any and all claims lor damages, costs. � <br /> �� ezpenses, or causes ol aclion that may arise because of inslallation <br /> �/� ��� �/1 � -, po and maintenance ol lhe improvement or other right•ol-way use hereto <br /> ,/L� � .i��C�1�✓ � n c1.L applied Wr and further a9rce5 to remove same upon notice from the <br /> �Approved lor Cons( cti ��� City and to replace public property damaged thereby. � <br /> � /-/�� _ p '_ <br /> /I � �a� ��-,w 7�%z/X � <br /> FINAL INSPECiION Date Date � <br /> qpproved as Constructed Signature ol APpGcant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> everelt PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � ;f200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PE7A11T M11AY BE <br /> Everetl,WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TN' <br /> Phone:259-8870 PROJECT OVER 90 DAYS DURATION. <br />