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�8t8_/�G f u0bt Wa:ka Permll� =r]��/ <br /> AppdcatiOn For eiaa�oeo�.•_� � <br /> � PUBLI� VUORKS PERMIT PuehcWorksFee <br /> Totel Fee s <br /> lese�OP�Feo PaiQ s__�_ <br /> Print or Type Only � B.�'�"o�° s .���- <br /> ��t/�?'K-U70�P�2 �020( �' tc►a�e►'y�a.� C1�E��If; --- <br /> Owner Mailing Address City Zip Phone <br /> SUo-ILl�C1 G LUAJST, �I7�S ��q��2 �'v��L4Ti � � �o-� ZS�S- zl �F <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��'�" � � ��'��7'— VL'Q'� <br /> �. �P� ,v.�T' <br /> Project Address(if known) �a20 l ��Lld.��Ca(� � � <br /> � <br /> Attach four(4)coE'es ol plans icr proposed worh- Drr.v. to scale and note the following as applicable: � <br /> • Property Lines • Centerlima of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposeA structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE OELOW THIS LINE <br /> PERMIT CONDITIONS Q <br /> 1. All calis for inspection shall be made?4 hrs. in advance•phone 259•8$1 5. � <br /> 2. All work shall be petiormed in ac�ordance with this permit and curreM City of Everett �esign and Construction <br /> Standards end Specifications <br /> 3. Call Location Underground Service 48 hrs. before you diy.TOLL FREE NUMBER 1-800•424•5555. � <br /> �j,l In/.Srat c � I>.Pf/ivB��c F�i> �;'u��= i��' O <br /> �.�.?!/�rJ S�l+c/% .C�iir9:/�/S <br /> � <br /> � <br /> 4� e �Is � <br /> o ��r� 11� � °' <br /> � a� L <br /> ' ✓�s ACKIJOWLEO(iEMENT OF CONDiTIONS <br /> The undereigmad owner/applicant he�eby agrees to hold and save harm• <br /> ' less ihe Ciry of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> ��� / �G� ZO and maintenance of the improvement or othe� right-ot-way use hereto <br /> !� �"`� ��^ applied lor and lurther agrees lo remove same upon noh�a from the <br /> Approved for Con ruction ate City and to replace public proporty damagetl thereby, <br /> � � J <br /> � . <br /> <�� .' ,� �_ �-�_ � �� �.���.eo�J �p��� <br /> FINAL INS TION Date � <br /> Approved as Constructed Signatur of Applicant ate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 81' THIS PERMIT MUST BE STARTEC WITHIN <br /> � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 13 TO <br /> 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPIETION.THIu PERMIT MA1' BE <br /> Everett,WA 98201 CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:25J•8815 PROJECT OVER 90 DAYS DURATIONy- " , <br />