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Date_./j(�{LY L Pu�llt Warkn r`ermii s �C��-� � <br /> •, �-i �V1�� <br /> Applicatlon For emo�oeo�.� <br /> PUBLIC WORKS PERMIT PU�7alaFeeFee S <br /> las:ApP�Fee Peld S <br /> Print or Type Only eai,��,o�, S 2��— <br /> � 8 <br /> �ic�s� ra ��on S -,��i �- 19 .- iVE /y1���1 r c2�/'�anG�i� �l�1� <br /> Owner MaiNng Address • <br /> ,, �-O j 47:1 <br /> 1.�C���c�'ZA' �..� Er ei r 1� �c�'oZQ< 3�4 S,$ • <br /> Applicant �ailing Address Ciry Zip Phone �—�` <br /> Doscribe Proposed Work _ Ai IO ii i _p� ���� ���� ���lE � <br /> � c��—�,A/�� �(' <br /> �h W <br /> Projecl Address(if koown) � + � _._. �. LOTy � <br /> �� E't�c-:F: �oo� G-t!. <br /> Attach taur(4)copies of plans for propo;edy+ork- Draw tc scale and notz Ihe following as a�plicable: <br /> • Property Lines /o// � <br /> • Centerline of;treet � <br /> • OuHine and dimensions of all existing and • Indicate��r!h <br /> Proposed structures on the Iot • Show any proposed grading changes <br /> • Existlng and proposed utilities • Show ireasuremenis <br /> DO NOT WRITF BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 7. All calls(or inspectior shall be matle 24 hra in advance- phone 259-881 5. <br /> 2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction ' <br /> Stendards and Speaficatlona <br /> 3. Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1•$00-424-5555. <br /> y E,e�STiN(s J>.C'ivc-t..�i9J/ D.�l TnYS L�JT TO dE ��En,y�!/EO � <br /> AivO �ECc+t1S'r.e�CTE'o �E.� G�Ts� ST.4�vG1a.e0,} +�.�a�. euiTi� O <br /> F�LG Nc/Gf1T Cel,C6 � �.GlTE,e/ T y'3ps <br /> .J /�iPo/�CSEO D.F/r��WAy M�isr i7E Co.c�CT.c:veYcJ f�6'� � <br /> c,� sre,�.o.a,z� �x so7. � <br /> � <br /> a <br /> ACKNO'.JLEDGEMENT OF CONDITIONS <br /> Thc undersi9ned o�n�ner/applicant herehy agrees to hold and save harm• <br /> less iha City ol Everott from any and all ciaims for damages, costs, <br /> �•� � expenses, or causes ol action that may arise because of Installation <br /> i �..a� �,��/�--,� and mamtenance of the improvement or other right-ohway use hereto <br /> Approved IQr Construction pa�e applied (or and lurther agrees to remove seme upon notice Irom the <br /> � City and to replace p_�bli property damaged thereby. <br /> 7 z ? -�c � <br /> FINAL INSPECTION Date ��"-- e�.,�� <br /> Approved as Constructed Signat of Appiicant Date <br /> everett PUBLI:WORKS DEPARTMENT WORK AUTHORIZED DY THIS PERIv11T MU BE STARTED WITHIN <br /> 3200 Cetlar Street 180 DAYS OF DATE PERMIT IS ISSUED A D THEFtEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO CCMPLETIC�N. THIS PERMIT MAV BE <br /> Phone: 259•BA15 CANCELLED BY THE CITY UPON ANY STO'�PAGE OF 1VORK ON THIS <br /> I PRCJECT OVER 90 JAYS OURATION. <br />