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. „ <br /> Date�-2 - U � I V �I NG p <br /> ! 0�TI Publ¢Wa�ks Perml�a _/Q•—�� <br /> Application For � ia9.oea�.. <br /> PUBLIC WORKS P�RMIT PUULCWorMSFeo <br /> p Total Fee S <br /> O Less ApPI.Fee PaN $ <br /> Print or Type Only � � g 9alanceDuo $ s�o oc <br /> � o <br /> w �" <br /> ^ O� <br /> M <br /> �f�'r JGF��7l��.F �,=/%��i11!'" �a ,G.�.S�l���i>> J`�','lS9 �9^�Of��iL <br /> Owner Mailing Address � r� x Cit <br /> O � � Y 7_iP F'hone <br /> �liiY/f Cly c�6Di�E � � � V <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work � (��//�!/ G� /OC.�Er ' CJ�-^.�lCJ �� ��.��j s� t�,�'' ��. <br /> 9/�l7 C1�O/JlJ ./)l'✓�rly�ai> .G%7- � / <br /> ��50 Tn ' L>,r �i6% Z�O f)'jE'r/iJ' l�lf SfGrlf/ :i>%� Z'�Y a F Ti <br /> c'i i �I'fr r��1 !I � t%at� �o c.E' � ' f//: � <br /> ProjectAddress(ifknown) '7�VS 1/l��N �O/J L-h• EvC�� � <br /> Attach four(4)copies of plans lor proposed work• Drew to scale and note the following as applicable: <br /> • Prope�ty Lines � <br /> • Centerline ot siree; � <br /> • Outiine and dimensions of all existing and • �ndicate North <br /> proposed structures on the lot • Show any proposed greding changes <br /> � Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW TH�S LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calis for Inspection shall be made 24 hrs.in advance•phone 259•$810. <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800-42Q•5555. <br /> `/. ��.�'�/�,; ,-,.�.�:=-t.� .�� 6�.; �;�,.- �/� �o�,�� ��-.�.- / Z <br /> �,,✓� �/ 5 <br /> �rn�u Iz�i�i /�a�.Z`y �!".G:tG .L 'htc�x.t�.ev»•J C1��..�7'n�,(/'a� �Q�fy; O <br /> O U <br /> �- a.��,��� _��-�.c�� -�,�ue Gz �P�,�� Xv .���-w � <br /> �� -� �.��'fai 6cu,�%aP.�,� <br /> S. .�clr�.s-s� —� 6e �c��C-'t` l�ii- CLC''`y S-fa.... �/ /� � <br /> U �-•d� 325�, O <br /> G ��.s���,f �� �a7��'�.,0�., � �.,��a��"�6�Jz � �6c,� � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The und•rsigned owner/applicant hereby agrees to hold and save harm- <br /> O�OE���"" less the Cit of Everetl from an and all claims lor damages. costs. <br /> OrE PS/'.ThY.c/t i. .>.vT. Y v <br /> expenses, or causes of action that may arise because ol installation <br /> ��s. �� /_�/ 90 and maintenance of the improvement or other iighbof-way use hereto <br /> ApProved for Construcli n� appGed br and lurther agrees to remove same upon notice irom the <br /> Date City and to replace public property damaged the�eby. <br /> �< y i� so � <br /> FINAL INSPECT�ON Date � �/�O <br /> Approved as Constructed Sgnature ol Ap¢licant Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8F. STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMiT IS ISSUED AND THEREAFTER IS TO <br /> Everet6 WA 98201 BE DILIGENTLY PURSUED TO COIv1PLETION. THIS PEqMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON AIJY STOPP�GE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />