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� �lication For <br /> PUBLIC INORKS PERMIT Date�A� ;o ��4� / <br /> 0 <br /> PUBLIC�RKS pEPqRTMENT <br /> 3z CedarStreet PublicWorkspe���q �Gj/+� <br /> Everett.�$aA207 259-8810 <br /> NPE OR PRINT ONLY Building permit# �— <br /> � � 5'i <br /> ' � w S� , �0 <br /> � � Public Works Fee <br /> q`' /V-, 'a� _�. <br /> Owner <br /> Mailing qddr � '+ �� <br /> � / M '� • y. City Zip <br /> J J \ t� Phone <br /> Applicant T <br /> MailingAddre � Ml�l.r/ds C�'n��� � <br /> . City ZiP - ,/ � <br /> Describe Proposed Work� Pnone <br /> �_� <br /> fl/Pc:9 v /� � <br /> ---��Y-u 1�r.�eP �lion � r�PN� � ` 'e' ■ � , <br /> �`'s�—�—�`:�h�b�., �d- _`�`.�,_`` W <br /> PROJECTADDRESS(if known) L l��1P /� � <br /> . Attach four(4)copies o(plans(or ` `� I Z ��Y , , � <br /> proposed•Nork•Draw to scale and note the foilowin�—y��pp���able: A <br /> • •Properly Lines butline and dimensions of all existin anJ 1�`'� ��Y�tAt r `„� m <br /> 9 proposed slructures on the lot � <br /> � •Centerline of street •Indicate North •Show an 'Existing and <br /> y proposed grading chan es • Proposed utilities O <br /> 9 Show measurements <br /> PERMIT COiJDITIONS: �� NOT WRITE BELOW THIS LINE ' <br /> 1. All calls for inspection shall be made 24 hours in advance- <br /> 2.All work shall be pertormed in accordance with this e phone 25g_gg�p, � <br /> Construction Standards and Specifications. P �it and current City of Everett Design and <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8pp_ O <br /> <t. Eros i o✓► cp vrlra 1 s h� I J be �n s kz,lle� a2a-ssss. � <br /> �'�-�� Publi� Wo�ks ins��r �� -t1�� d�rect,oN � <br /> �, C�. � ce„-(� t �1�.e ,�f a �fe y �,�dc. o.� z �. � +Z, � <br /> s�r�., p� <br /> � ACKNOWLECGEMENi OF CONDITIONS <br /> AP� e��O1 C9 ion �� _ h QCity ot�Everett f omrany and allhclaims for dama esticostssexe ens s1eor <br /> / J Data causes of action that may arise because ot installa9on and m�in enanc=of <br /> the improvement or other nght-of-way use hereto applied�or and turther agrees <br /> 2't ��-- / � to ramove same upon notice from the City and to replace public pro <br /> FINAL INSPECTION ��� ' damaged thereby. <br /> Approved as Constructed <br /> Date Pertv <br /> � <br /> �. �' �� /� J s7 / <br /> WORK AUTHORIZED BY TH�g pERMIT �Ignature ol Applican—1 ��� ��l.0 <br /> COMPLETION.THIS PERMI7 MAY BE CANCELLED BY THE CIIY UPON ANY STOPPqGE OF WORK ON TF{�S PROJECT OVER 90 DAYS DURq710N. Date <br /> UST BE S7ARTED WITHIN 180 DAYS OF DATE PERMI7IS ISSUED AND THEREAFTEq IS TO 8E DILIGENTLY PURSUED TO <br />