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i <br /> Date_� Pu�lm Worke Pnrmll• �!l' � / �/� <br /> �� Application For eiaaoen�.•� � 7/T—_. <br /> PUBLIC WORKS PERMIT PuLTaleFeaFee s <br /> Less Appl Fae P�1A S <br /> Bal�nce Oue S �� <br /> Print or Type Only <br /> S�PJQ. Sr �ni'ti'vN�ti .S�oZ� S. �itf�1 /.�`� �rrro�Js ��f�_�i1- 7�Z— <br /> Owner Mailing Address Cily Z�p Ph�ne <br /> 5w 1 <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposed Work �C/�G'�� 'MrNI� rrrirpe�c� <br /> L�!-" �qT�3lnck 7J l�14� n� �. nPl�,.i �7�- <br /> n W <br /> Project Address(if known) ����— C��f����=�C���� A�.Z, � <br /> Atlach four(4)copies ol plans br proposed work• Draw to scale and note the lollowing as app�icable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norlh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BFLOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advanco• phone 259•881 5. � <br /> 2. All work shall be peAormetl in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. helore you dig.TOLL FAEE NUMBER 1-800•424•5555. � <br /> ,��s+e �e�+ta�.��e e.�r.�rns�--- � <br /> r7P.�LiGh'�vT I�A� &'E .F�'4t-�.c�o To Fi�L Fi_'o.✓T � <br /> ,�- BqG/l v�' �cr Ta Bao�a I�f�A..v9�,E P,��oij�E�,�s <br /> #� Fo���✓�vro�v Foor�.r.� s,�iov,co .v�r � � <br /> �C�c�v d.t/ F�LL m�IrEC'/AC. u.tJ[:Ess /T /-S O <br /> Ca/i. �,9.'•'"F.o To ti.viF_�i�i,� f�v�c,Gv,�/l �'ovE 5;9.��/�'�,�5, � <br /> CG iY<li?�c�.Z ?(_> <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneUapplicant he�eby agrees to holA and save ha�m- <br /> less the City ol Everett irom any and a�l claims lor damages. costs. <br /> // expenses, or causes of action that may arise because ot installation <br /> a--_��� ��Fy� �- SyG and maintenance o( the improvement or other righhol�way use hereto <br /> «� applied (or and further agrees to remove same upon notice Irom the <br /> pproved for on r ion Date City and "�piace pyW�property damaged thereby. <br /> .����-rf'� � �7i / <br /> FINAIINSPECTtON Dale �� > -�--��! �'� <br /> Approved as Corstructetl ture cl Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT RK AUTHORIZED BY TI1IS PERMIT MUST BE STARTED WIcHIN <br /> � 3200 Cedar Street 1� 0 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER I., 70 <br /> Everett.WA 98201 �BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH15 <br /> PFOJECT OVER 90 DAYS DURATION. <br />