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VuUim WorMs Permit� '�� �/G,� <br /> Date 7�� _ <br /> ditlB Dept� <br /> Applicaticn ror _ <br /> PUBLIC WORKS PERMIT PUbTa�IFooFce $ _ <br /> Less APP�-Fee Pm0 $� <br /> Balin:c Oua S ��"� <br /> Print or Type Only <br /> ��VI � -�W�Z�`j 315 G�cWN I�fi �l-'�(�i�11- ���7r� 1 '�5�7� '1 S .S� <br /> Owner <br /> Mailing Address City ZiP Phone <br /> � <br /> �1���� )���1,H 5'��sTSK �Un;l �ifi'7`'�D j� l� � - In�r_� <br /> Applicant Mailing Address Ciry ZiP Phone <br /> �esCribe ProPosed Work I V�-�- YY W�l,' � 1 1'C ��� I 1�1;1 —1 ��N�'l�L r��l� " ��//IIl-� <br /> - W <br /> i Project Address Iit known) e� „ L^ � ?'�-Y��-Y � � � <br /> � <br /> I Attach lour(4)copies of plans lor proposed work- Draw to scale and note ihe tollowing as applicable: � <br /> � • Property Lines • Centerline ol street <br /> ' � Outline and dimensions of all existing and • Indir,ate North <br /> � proposed struCtures on the lot • Show any proposed�rading changes <br /> • Exisling and proposed utililies • Show measurements M <br /> W <br /> IDO NOT WRITE BELOW THIS IINE O <br /> i <br /> 'I PERMITCONDITIONS � <br /> 1.All calls for insDection shall be made 24 hrs.in advance-phone 259•881 O. <br /> 2.All work shall be pertormed in accordance wilh this permit and current City ol Everett Design and Construclion <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � .�� �dcru', .,{o fie �� �c�e-a a�l��-�� /��o�v o�a.leo� O <br /> /O-27-88 �2�""c�e.l'ce�� � <br /> 5, �i�Cc��n.7't � ,Q/�v�� /?!/t�vzr»ci.,,.o.� c,ti,a.��:n�y �'�-' � <br /> i O�Gf �a.c,�,�(�2soo) . fl,uU iJEPv-sz�T '�isao�° �i'L <br /> � a�'t4.' GU�'�; /. �f � '�nJ2�� ,���"u N�cL'���� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned ownedapPlicant hereby agrees to hold and save harm- <br /> , less the Crty ol EvereU from any a�d all claims lor damayes, cosls. <br /> / ezpenses, or causes of action Ihat may arise because of installation <br /> ������ `q ,�j a�� maint?nance ol lhe improvement or other nghbohway use hereto <br /> �U/G�/� a lied for and luriher agrees to remove same upon notice from Ihe <br /> Approved lor C nstr ion / Date City and to replace publi properry damaged ihereby. <br /> ���c�� S=/-��_ <br /> FINAL INSPECTION Date ' Date <br /> � Approved as Constructed Signature o1 Applic nt <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED NIITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br /> � � 3200 Cedar Street BE DILIGENTLY PURSUED TO CUMPLETION.THIS PERM:T MAY BE <br /> Everetl.WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•�810 PROJECT OVER 90 DAYS DURATION. <br />